Forms/Policies

FORMS

New patients and current patient information updates:
New Patient Form/Old Patient Update
Patient Information Sheet
Patient Consent Form
Notice of Privacy Practices
Medical Release Form

POLICIES

New Patients
-By physician referral only
-Dr Trippe is not a Medicaid provider
-United Health Care subscribers should check with their provider to see if Dr. Trippe is included.
-No smokers

Treatment

-Patients are requested to refrain from smoking at all times during their treatment.
-Samples only provided on day of doctor visit.

Missed Appointment Fee
-$50 charge for missed appointments not cancelled in a timely manner.

Lab

-Do not eat or drink anything, except water, after midnight the day of any lab appointment

24 Hour Urine Collection

1. Discard first urine specifmen in the morning.
2. Collect all following urine specimens for 24 hours.
3. Keep specimen cool for 24 hours (by placing on ice or in the
refrigerator)
4. Return specimen to clinic after completing your 24 hour
collection between the hours of 7:00am and 10:30pm.
5. Please check with lab tech before leaving specimen.

Ultrasound Policies

Nothing to eat or drink within 6-8 hours for kidney ultrasound or RUQ.

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