4525 West 6th Street Suite 100
Lawrence, KS 66049
(785) 843-5160
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Privacy Policy

CONTACT US

BILLING INFORMATION

Our staff will make every effort to simplify and help you with billing and insurance claims procedures. As a courtesy, we will file insurance claims on behalf of patients. When an insurance claim is denied, we will make a reasonable effort to appeal those decisions when appropriate. As a service, if we are aware that a particular test or procedure is routinely not covered by a specific insurance, we will use our best effort to make you aware before the service is rendered.

Major Plans We Participate in:

We participate in most insurance plans including:

  • Blue Cross & Blue Shield
  • Medicare
  • United
  • Coventry
  • Aetna

Plans We Currently Do Not Participate in:

  • Humana HMO
  • TriCare HMO
  • Harrington / Sprint
  • WPPA HMO

If your plan is not listed, ask us about your specific plan.

Personal Information
First Name
M.I.
Last Name
E-mail Address
Phone
Bold = Required field
Date of Birth
Social Security Number
Are you currently a patient?
Yes
No
If you are a new patient, who referred you to The Internal Medicine Group?
If different from your referrer, what is the name of your Primary Care Physician? (If none, answer none)
Choose your Doctor or Nurse Practitioner

E-mail Security Disclaimer:
The form on this page is sent through e-mail, which is not a secure method of communication. If you would rather not
take the risk of sending personal information by this format, please contact our office at 785-843-5160. By using any
of our e-mail functions, you acknowledge that you have read this notice and agree to the "risks."

DO NOT USE THIS FORM FOR EMERGENCIES OR URGENT MEDICAL PROBLEMS—please call us to speak
directly to the nurse. If we have not responded by the third working day by phone or e-mail, please call.

The Internal Medicine Group requires information marked with an * to contact you. Your social security number is not required, but does assist us in tracking your records.

MAP & DIRECTIONS

Map4525 West 6th Street
Suite 100
Lawrence, KS 66049
(785) 843-5160

Click on the map for an expanded view.

Click here for directions.

Ambulance
Email Available January 2009
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