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Patient Information

Patient Check-In

When you arrive at our facility, please check in with a receptionist. As a new patient you will be greeted at the reception desk and asked to complete several forms to establish your record. In order to do this, please bring:

Photo Identification

  • Government issued ID

  • ​Employee ID

  • School ID

Insurance Information

  • Your insurance card

  • The address of your insurance company

Health Information

  • Past hospitalization and surgeries

  • Family medical history

  • List of all medicines being taken

  • Record of all immunizations

  • Motor Vehicle Accident information, if applicable

  • Workers Compensation information, if applicable

Please tell the receptionist at the time you register whether or not you wish to have previous medical records transferred. If so, you will be asked to complete a transfer form.

Downloadable Patient Forms


We operate by appointment only. The care coordination team will ask about the nature of your problem, in order to allow enough time for your appointment. In some cases, you may be asked to speak with a nurse who will determine appropriate services.

If you are unable to keep your appointment, or will arrive late, please call the office at least two hours in advance of your scheduled appointment.

This courtesy allows us to provide service to other patients. The practice has a "NO SHOW" policy for repeated broken appointments that have not been cancelled. After repeated failures to keep or cancel an appointment, a patient will have their service discontinued so that others may be better served.

To schedule an appointment please call (618)536-6621 for our Carbondale office or (618)932-3937 for our West Frankfort location.

Medication Refills

Please contact the pharmacy of your choice for refills. Ask the pharmacy to contact us for physician approval of your refills. The SIU nurse may be contacted between 8:30 a.m. and 4 p.m. for refill assistance. A 48-hour notice for medication refills will be required. Authorization for refills is not available during non-office hours.

Controlled substance refills will not be completed on Fridays. Patients making a request on a Friday will be directed to call back on Monday.


The Faculty utilizes a closed circuit television system in a highly confidential manner as a part of resident training. You will be asked to sign a form consenting to the use of the system during your visit. If you have any concerns about this aspect of the program, please talk to a member of the staff.

Your care is strictly private. No information regarding your care will be given without permission, except when required by law.

Billing, Insurance, and Collections

You are expected to make payment at the time that services are provided.

If you have insurance coverage, you are still required to pay any copayment amount at each visit. Our insurance specialists will bill for Medicare, Department of Healthcare and Family Services, Carbondale Township, HMO, and other insurance coverage. We will be happy to assist you with any insurance claim questions.

For those patients who are self-pay or who have insurances that do not cover office visits, payment is due in full at time of service.
For your convenience, copayments and balances due can be made in our office. We will gladly accept cash, checks, Visa, MasterCard or Discover.

Our insurance policy requires a personal payment each month on outstanding accounts. In case of non-payment, patients are given adequate time and notice to settle their account, but our office strictly adheres to an established collection procedure. Delinquent accounts are turned over to a collection agency and service can be permanently terminated.