KSC PATIENT INFORMATION

POLICIES & FORMS

We offer state-of-the-art treatment for patients who have rheumatoid arthritis, lupus,
osteoarthritis, and many other autoimmune diseases, as well as osteoporosis.

To make sure your appointment goes smoothly from the start, read through our policies and fill out any needed forms before you come in. If you have any questions, call us at 660-956-0716 .

Referrals for Your Appointment

Many health plans require a referral before a specialist can see you. Check with your health insurance company to see if you need one before you schedule your appointment.

If you need a referral, call your primary care doctor’s office and have the following information ready:

  • Your name and date of birth
  • Daytime phone number
  • Name of insurance & ID number
  • Name of specialist / facility
  • Reason for specialist visit
  • Make sure your referral is sent to us (or you can bring a paper copy) before your appointment.

IMPORTANT: Our providers and nurse practitioners cannot see you if you don’t have the completed referral.

Arriving for Your Appointment

  • Please come in 30 minutes before your scheduled time.
  • Check in with our front desk team. Tell them your name and provide any insurance information, referral (if not electronic), lab results or imaging studies.
  • Pay your insurance copay amount.

Cancellations

If you need to cancel an appointment, call us at least 24 hours before your appointment or we will have to bill you for a visit anyway.

If you call at least 48 hours before your appointment, we can let another patient use that appointment slot in your place, so you won’t be billed.

See our Health Insurance page for more information on referrals, copays, claims and health plans we accept.

Patient Forms

New Patient Form – Save time by printing and completing this form before your first doctor’s visit at Kirksville Specialty Clinic.

Infusion Assistance Form – Need help paying for your infusions? This list matches up infusion drugs with programs offering financial assistance.

Authorization for Release of Records – If you’d like your health care information shared with another doctor, fill out this form.

Care Credit Patient Payment Plans – Pay your health care bill over 6 months, with no interest.