Forms & Payment


To expedite your visit, please complete the forms below and bring them with you when you come in for your appointment.  In order to provide the best medical care possible, please also arrange to have all medical records sent to our office and bring the following: 

 

Photo ID

Insurance Card

Medications or Medications List

 

Please note that all co-pays are expected to be paid at the time of service.

 

For your convenience, payments may be made by cash, check or credit card.  Payment is expected at the time of service unless you have made other arrangements.  If you are experiencing a financial hardship, you may qualify for coverage under the Roper St. Francis Healthcare Financial Assistance Program.  Please ask our staff for more information or contact the Billing Office at (843) 789-1620.  We ask that you check with your insurance carrier prior to your visit to ensure scheduled services are covered benefits. 

 

We value you as our patient and thank you for choosing Carolina OB/GYN.



Forms bullet Patient History Form
 
Forms bullet Notice of Information Practices
 
Forms bullet New Patient Information Form
 
Forms bullet Billing Practices Notice
 



OFFICE HOURS
Mon. - Thurs.   8:30 a.m. - 5 p.m.
Friday             8:30 a.m. - 1 p.m.

We welcome new patients.
Same day appointments
are available.

You will have the ability to Renew Prescriptions with MyHealth.
You will be able to schedule appointments with MyHealth.
Home  :  Privacy Statement  :  2145 Henry Tecklenburg Drive  :  Suite 270  :  Charleston, South Carolina 29414  :  (843) 577-0220
© 2012 Roper St. Francis Healthcare

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