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Tampa: The Centers For Vulvovaginal Disorders Patient Registration

The Centers for Vulvovaginal Disorders: Tampa

1.Date of scheduled appointment (Required.)
2.Select the location of your scheduled appointment:
3.Full Name(Required.)
4.Date of Birth (Required.)
5.What are your pronouns?
6.Home/Mailing Address(Required.)
7.Cell Phone Number (enter NA in none)(Required.)
8.Home Phone Number (enter NA if none)(Required.)
9.Work Phone Number (enter NA if none)(Required.)
10.Email Address (enter NA if none)(Required.)
11.Preferred method of communication(Required.)
12.Emergency Contact - name and relationship(Required.)
13.Emergency Contact - phone number (Required.)
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16.IMPORTANT POLICIES OF THE CENTERS JILL KRAPF, MD

Your First Appointment:
New patient appointments are approximately 90 minutes, but we ask that you set aside 2 hours in the event that your appointment requires more time. If English is not your primary language, we advise you to bring someone with you to translate and assist you throughout the appointment, as needed. Please contact our website for our address and directions to our office: www.jillkrapfmd.com.

Your Providers and Care Team:
Our providers are considered world-renowned experts on vulvar disease. As such, we frequently have visiting health care providers shadowing our physicians to learn from us and spread awareness. You reserve the right to refuse to allow them to be present during your visit. *Please note that some of our providers have a scribe present throughout the entire appointment to detail your comprehensive visit. These scribes are employees of Jill Krapf, MD. Our scribes handle the note-taking and box-ticking of modern-day medicine, allowing our providers to have more face-to-face time with the patient.

Required Paperwork:
The Vulvar Pain Questionnaire AND Registration form must be completed 48 hours prior to the visit. Our providers will not consult with or examine you unless you have completed these medical intake forms. Both documents can be found on the main CVVD website at www.cvvd.org/contact, which is also linked through www.jillkrapfmd.com. If the paperwork is not done at least 48 hours of scheduling the appointment, a 10% surcharge will be applied to the visit fee upon check out. *We also reserve the right to cancel appointments if paperwork is not received.*

Your provider will review the answers to your questionnaire and may ask additional questions during your appointment. This confidential questionnaire will become part of your medical record. This data may be tabulated (without your name) in the course of research studies to learn which factors seem most important in evaluating other patients with these similar problems. In addition, you may have photographs of your genitalia taken during this visit; you may refuse consent.


These policies help to ensure that all required paperwork is completed in a timely fashion which allow our providers to prepare for your appointment. Incomplete paperwork or paperwork turned in last minute places great strain on providers and staff and limits our ability to thoroughly review your very important medical history. We strive to provide patients with the best care and thank you for assistance.

The Centers for Vulvovaginal Disorders including the Washington, DC and New York locations share an Electronic Medical Record with Jill Krapf MD at the Tampa, Florida office. You are giving permission for your providers and care team to access these records as applicable to your patient care across the offices.(Required.)
17.PAYMENT POLICY
Our policy is that payment is to be made at the time services are rendered. Whether or not your insurance pays in full, a portion or nothing at all for services is a matter between you and your insurance carrier. Payment is accepted in the form of cash, check, money order, or credit card. The patient agrees to pay a $250 cancellation fee if the appointment is not canceled or rescheduled 1 week prior to your appointment time. To complete scheduling, we require a form of payment on file. There will be no charges made until after your appointment, unless the cancellation fee goes into effect.
*We do not accept CareCredit.



CANCELLATION POLICY:
We at Dr. Krapf's office value your time and understand that unforeseen circumstances may arise that could force you to postpone or cancel your appointment. We Kindly request you review our cancellation policy to ensure a seamless experience for all of our patients.

1. We require at least at least 1 week notice if you need to cancel or reschedule your new patient appointment. This allows us to allocate this time to another patient.
2. If you cancel your appointment less than 1 week before it is scheduled to take place, or do not show up for your scheduled appointment, you will be subject to a cancellation fee of $250.

LATE POLICY:
If you arrive 30 minutes or later, your appointment will need to be canceled and rescheduled. There is not enough remaining time to provide the thorough care you deserve or to avoid delaying other scheduled patients.

A $250 late cancellation/no-show fee will apply. This fee reflects the reserved physician and staff time, which usually cannot be offered to another patient at short notice.

If you expect to be late, please contact our office as soon as possible. Exceptions may be considered for documented emergencies or circumstances outside your control.

**Please note: Jill Krapf MD is not responsible for any costs that you incur as a result of the cancellation or rescheduling of your appointment including (but not limited to) flight cancellation/change fees, hotel cancellation/change fees, or lost wages. As such, we STRONGLY encourage you to get FULLY REFUNDABLE tickets and/or reservations.


PAYMENT AND INSURANCE POLICY:
Jill Krapf MD offers patients comprehensive health care which
limits our ability to work within the limitations of the health insurance industry. Due to this, we do not accept insurance, and our office does not communicate with insurers, respond to insurance inquiries, participate in appeals, or assist with claim disputes or processing issues. As a very small practice, we do not have the administrative capacity to manage these matters. If you are a Medicare beneficiary, please note that we have formally opted out of Medicare.

This means:
*Neither you nor the practice may seek reimbursement from Medicare for services provided.
*You will be required to sign a Medicare Private Contract acknowledging that you understand and agree to these terms.

Appointment Cost:
The cost for a new patient appointment is $1900 for new patients seeing Dr.
Jill Krapf at her Tampa, Florida office. Payment, in full, is required at the time of service. We accept all major credit cards, cash, and checks (from a US banking institution).

Labwork:
All labwork performed during the visit will be sent to Quest or Labcorp (further referenced as "the lab") for processing. We will provide them with your insurance information so that they can process/bill your labwork through your insurance company. If you are uninsured or there is any gap in coverage for labwork performed, the lab will contact you d
18.In order to secure your new patient appointment, and as part of our cancellation policy, we require a credit card on file. 1. Your credit card information will be stored securely, and will only be charged if the cancellation policy comes into effect. 2. If you cancel your new patient appointment less than 1 week in advance, or fail to show up for your scheduled appointment, we reserve the right to charge your credit card the $250 cancellation fee. 3. No charges will be made to your credit card without your consent. Please understand that our cancelation policy is in place to provide the best care possible to you and all of our valued patients. We appreciate your understanding and cooperation.
19.FMLA and Disability Paperwork

As a small specialty practice, we encourage patients to first request FMLA and disability paperwork from their primary care provider, who can best address overall health and work-related needs.

If our office completes forms related to care provided by our practice, there is a $150 fee per form. This includes additional forms, extensions, or recertifications. Fees are due before forms are completed.

Please allow up to 10 business days for processing.
20.Credit Card Information To Keep on File
21.***Please provide your insurance information in the space below (enter N/A if none) OR upload your insurance card (skip to questions 19 and 20). This information provided to our labs for specimen processing.(Required.)
22.Please upload an image of your insurance card. (FRONT). 
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23.Please upload an image of your insurance card. (BACK)
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24.Special Note:

Comprehensive medical care for vulvovaginal pain requires an ongoing therapeutic partnership, and single-visit cures are not medically realistic. Fees cover the specialized clinical time, comprehensive evaluation, and diagnostic expertise provided during your appointment. Because chronic pain conditions are complex and require multi-step management, we do not guarantee curative treatment.
25.By typing your name below, you are acknowledging that you have fully read and completely understand Dr. Jill Krapf's office and payment policies, as discussed above.
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