Sall Myers Patient Forms

Accident Patient Forms

Before your first visit, please be sure to bring the following:

  • Photo Identification (preferably drivers license)

  • Social Security Card

  • Insurance Identification Card

  • Insurance Declaration page (outlining the tort threshold and type of coverage)

  • Police Report

  • Health Insurance (if applicable), we do not participate with any health insurance providers however if there is out of network benefits, as a courtesy to the patient we will balance bill the deductible and co-pay not covered by the motor vehicle insurance.

  • If you are on medication the doctor needs to know. (List of medications)

  • If you are not the insured the insurance carriers now require proof of address before the motor vehicle accident.

  • Please also bring the below forms.

Below are the forms you will need to bring in (Click to download):

Contact us

Please call us at 866-609-4448 to schedule your consultation, or fill out our Quick Contact Form.

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