Patient Forms: We recommend you print and fill the forms on this page before your appointment. This will speed up the process especially if you are a new patient or if you have not been seen in this calendar year.
Please print the applicable forms:
- 2021 HIPAA Patient Privacy Form (All Patients)
- 2021 New Patient Demographics (New Patients)
- Medical History (New Patients)
- Patient Preventative Care Questionnaire (Patients Over 50 Years Old)
- Concussion/Head Trauma Symptoms (if applicable)
**WE DO NOT SEE CASES FOR MOTOR VEHICLE ACCIDENTS, PERSONAL INJURY, OR WORKERS COMPENSATION**
Please complete the applicable Physical Therapy Forms
Additional Forms (if needed):
- Annual Well Visit Notice
- Medicare Chronic Care Management
- Medical Records Release
- Controlled Substance Patient Agreement Form
At Princeton Sports and Family Medicine, we are committed to working with you in your efforts to get better. To comply with state and federal regulations, Princeton Sports and Family Medicine, P.C. has developed the policy outlined in this agreement regarding the use of controlled substance medications.
Princeton Sports and Family Medicine offers two brochures for your convenience. You can download to read or print these brochures:
If you are here to see one of our Sports Medicine Doctors and your Insurance requires a referral from your Primary Care Physician, and you do not have one, you WILL NOT be seen. Please call your Primary Care Physician and request the referral before you schedule an appointment.
If you are a current Sports Medicine patient, you must have an up to-date referral before being seen.
If one of our PSFM Doctors is your Primary Care Physician and your Insurance requires a referral before you can be seen by another Physician, or before you have Lab Work or Imaging Studies, our staff requires at least a 72 hour notice to submit your referral.
Please be aware that it is Your Responsibility to understand what is required by your insurance. Thank you in advance for your co-operation.
Cancellation / No Show Policy:
We understand that there are times when you must miss your scheduled appointment due to emergencies or obligations for work or family. However, when you do not call to cancel your appointment, you may be preventing another patient from getting much needed treatment.
IF your appointment is NOT CANCELLED at least 24 hours in advance, you will be charged a fee of $30.00; this fee will NOT be covered by your insurance company.
Accepted Insurance Companies: At this time we accept following insurances. If you have any other insurance plan, please check with our office before making an appointment.
- Aetna/Coresource/Meritain Health/1199SEIU Benefits/MHBP
- Amerihealth/Amerihealth Administrators
- Bankers’ Life and Casualty
- Bollinger Insurance
- CDPHP Universal Benefits/Cerner Health/Keysolutions/Key Benefit Administrators
- Colonial Penn Life
- Consolidated Health Plans
- Coventry/Health America/Health Assurance
- Genworth Life and Annuity
- Horizon Blue Cross Blue Shield/Blue Card
- IBC/IBC Administrators/Keystone Health Plan East/Personal Choice
- IE Shaffer (IBEW Local 269 Welfare Fund)
- Multiplan/PHCS/CWIBenefits/Health Smart
- Mutual of Omaha/Physicians Mutual
- Nippon Life Benefits
- Philadelphia American Life Insurance
- Transamerica Premier Life Insurance Company
- Tricare East (Humana)/Tricare 4 Life
- United American Insurance Company
- United Healthcare