To our patients,

Below you will find a summary of our office policies and a statement of our medical principles. We look forward to meeting you.

For patients wanting a initial complete evaluation, there is a questionnaire to fill out. You may ask the secretary to send you this form. Please read this questionnaire carefully and answer to the best of your ability. Please write your answers neatly (or type) on separate 8 ½ x 11 sheets of paper. Be concise and bring your responses with you to your first visit. Thank you.

I. GENERAL OFFICE POLICIES

Hours: Our office is open from 9:30-5:00 on Monday, Wednesday, and Friday.

Telephone calls: An answering machine will answer calls when the office is closed or when the staff is busy. Be sure to leave your phone number on the tape. Dr. Chernin can be reached by calling his beeper if there is an urgent need. Another physician takes call for Dr. Chernin when he isn't in the office.

Fees: There are two types of initial appointments. The initial complete evaluation (first visit) consists of a review of the patient's medical history, present symptoms, nutritional status, and physical exam. The fee is $220 for adults and $150 for children. This includes any special instructions in exercise, diet, relaxation technique, tai chi, or yoga, etc. The initial consultation evaluation reviews a specific medical problem and decisions are made for further treatment and beginning therapies may be prescribed. This fee is $140. Return visits are $65. Remedies or suggested supplements are charged separately. The initial evaluation is approximately 45-60 minutes with Dr. Chernin and staff. Individual meditation/breathing instruction lasts 45 minutes and the fee is $130. Psychotherapy sessions are also 45 minutes and the fee is $130.

Payment: We ask that patients pay in full at the time of the visit. This also applies to patients with insurance policies that reimburse them (Blue Cross, Medicare, or Aetna, etc.). Please bring your own insurance form, if applicable. If you have a managed care plan in which Dr. Chernin participates, please bring your card or ID This includes Care Choices, Preferred Choices, CIGNA, MCare, or HAP.

Cancellations: We ask that patients give us as much advanced notice as possible (at least 24 hours) if they need to cancel an appointment. Patients may be charged for missing an appointment without notifying us.

Labs: We call patients when lab results return and are abnormal. Patients should call us within two weeks for the results of their testing if they want to know their results and haven?t heard from us.

Release of information: Insurance companies often request your records when you sign a release. Please indicate if you do not want this questionnaire released.

II. PRINCIPLES OF THIS MEDICAL OFFICE

Patient Role: Self-responsibility and active participation in improving you own health are very important aspects of this practice.

Goal of this Medical Office: We offer appropriate therapies and methods to help guide the individual and family to maintain health, prevent illness, and to treat already existing diseases. We practice preventive medicine: this implies balance of body, emotions, and mind.

Role of the physician and staff: Dr. Chernin is a general/family practitioner and medical consultant, has done residencies in Preventive Medicine and Psychiatry. He is board certified in Preventive Medicine. We are available to treat many acute illnesses, coordinate medical subspecialty referrals when necessary (obstetrics, gynecology, cardiology, etc.) and to treat many chronic illnesses. Although Dr. Chernin is affiliated with Saline and St. Joseph Hospitals, he seldom admits people to the hospital and instead refers acute emergencies or complicated cases to medical specialists, to other close associates, or to the local emergency rooms.

III. LOCATION

We are located on the second floor of the Parkway Center, a beautifully restored Victorian building built in the 1880?s. The two houses that are interconnected were moved in 1987 to their current location from Main Street in downtown Ann Arbor.