Patient Information

Hospital Affiliations

• Holyoke Hospital, Holyoke, MA
• Baystate Medical Center, Springfield, MA
• Mercy Hospital, Springfield, MA
• Noble Hospital, Westfield, MA

New Patient Forms

For your convenience, you can print out the following forms before your appointment. Please bring the completed forms to your first office visit. [printable page help]

• New Patient Registration Form
• Patient History Form
• Patient Consent Form (regarding consent to the Notice of Privacy Practices)

Notice of Privacy Practices

Patients will be asked to sign a Patient Consent Form to consent to our Notice of Privacy Practices. This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

Your First Appointment

Please arrive early so that we can complete your initial paperwork. Also, please bring the following:

• Patient's insurance card
• Recent test results, x-rays, or relevant records
• Completed new patient forms if received in advance, or be prepared to provide:
  • List of current prescriptions and/or over-the-counter medication, including dose and frequency
  • Information about patient's medical and surgical history

Insurance and Payment Information

Hampden Family Practice is a provider for Medicare and most major insurance plans, and provides insurance billing. You are responsible for co-payments or charges that are not covered by your insurance. If you have questions regarding billing or which insurance plans we accept, please contact us. Questions regarding insurance coverage and benefits should be directed to your employer or insurance company.

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