We ask our patients to complete these forms before their first appointment. Please click on the links below, print the forms and fill them out before coming for you first visit.

• ADULT PATIENT REGISTRATION FORM
• CHILD PATIENT REGISTRATION FORM
• NEW PATIENT MEDICAL HISTORY FORM

Note: These files are in PDF format. If you do not have Adobe® Reader® on your computer, you can download it for free by clicking here or on the Get Adobe Reader icon.

In addition to these forms you will be responsible for bringing the following:

1. Current Drivers License or photo I.D.
2. Insurance Cards
3. A current list of medications and dosages (if possible, bring original bottles) 
4. A referral (if required by your insurance)
5. Any diagnostic reports or tests pertinent to your appointment (i.e.: CT reports or X-ray images)
6. If you have Power of Attorney over the patient, you are required to bring all of the necessary paperwork to the appointment.
7. If you have child custody and medical responsibility established by a court decree, you are required to bring a copy of the decree to the appointment.

It is required by law for all minors to have a parent or guardian with them to be seen by the doctor.  If the parent or guardian is unable to accompany the patient to their appointment, they must sign an authorization stating who may bring the patient to the appointment.

INSURANCE

Please bring your insurance card and any other pertinent insurance information.  As a courtesy to you, our staff will help you file the medical claim to your insurance carrier.

If you are involved in a work related injury or accident, please supply the office with complete billing information.  Written authorization from your employer or adjustor is required prior to the date of service. 

Dr. Lyons participates with Medicare, Blue Cross & Blue Shield, Midland's Choice, Interplan Health Group, Mutual Medical Plans Inc., Quincy Health Care Management/Riverquest, Corvel Corporation, Community Based Health Plan (CBSA), John Deere Health Care (limited to: Select plan, PPO plan, HAWK1), Progressive Benefits Services, and Iowa Medicaid. 

Dr. Lyons does NOT participate with HAWK1 programs (with the exception of HAWK1 through John Deere Health Care), Iowa Care, or Illinois Public Aid.

CO-PAYMENTS AND DEDUCTIBLES

Co-payments and deductibles are due at the time of service. 

If you do not have insurance coverage, we will collect payment in full at the time of service.  If you need to make payment arrangements, or have any questions regarding payment, please contact our office PRIOR to your appointment.

Prompt payment is required for any outstanding balance.  Payment is due 30 days after the date of service.  Dr. Lyons' office accepts payment in cash, by check, money orders, and Visa or MasterCard.

There are instances when insurance companies will not cover elective surgical procedures. Our office can help you find a financing program that is right for you.  Several financing options are available through CARE CREDIT patient payment plan.  Please contact our office for further details.

APPOINTMENTS

New patients are always welcome.  Our staff will be pleased to assist you in any way possible.  All efforts will be made to accommodate your schedule.  Referrals are not necessary unless your insurance company requires that you have one.  Our staff will be pleased to schedule a referral from your health care provider. 

We do ask that you notify our office at least 24 hours in advance if you are unable to keep the appointment.  This courtesy on your part will make it possible to give your appointment to another patient.

EMERGENCY

In the case of an emergency, when you are in need of immediate medical attention or transportation to the hospital, call 911!

You may contact our office during regular business hours at 319.753.6771. If the office is closed, please contact the Great River Medical Center's Emergency Department at 319.768.4700.