Brookshire Family Practice Financial Policy/Administrative Services Fee
Our team is committed to meeting your healthcare needs.  We appreciate your business.  In order to accomplish this in a cost-effective manner, we ask you to adhere to the following guidelines:
 ●	All patients are responsible for all payment of services.   All time of service payments MUST BE PAID IN FULL during patient check in process at each visit.
 ●	Same day appointment cancellation & appointment “No Show” will result in a charge of $125.  Payment will be due at check in on the next scheduled appointment.
 ●	There is a $75 adminstrative fee for the completion of forms
 ●	New Patient Visit-Uninsured fee is $175 - $225 depends on visit type(excludes any additional services).  
 ●	Established Patient Visit-Uninsured is $125-$150 depending on visit type(excludes any additional services).  Additional services include urine drug screens, laboratory tests, completion of forms, etc.
 ●	The majority of prescription refill requests may require an office visit.
 ●	In some cases, complex visits may result in additional fees due to the number of topics that need to be addressed and length of the visit.  The additioanal fees can be $35 or more.
 ●	Copy of medical records fee is $25 up to 20 pages and $.50 for each additional page thereafter