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Capital Neurological Surgeons

Capital Neurological Surgeons

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Policies + Forms

Policies + Forms

Our intention is to make your visit to Capital Neurological Surgeons as smooth as possible. We make every effort to ensure that you understand your financial obligations for our professional services prior to incurring any costs, and we will always discuss with you the fees for our services.

Financial Policy

All copayments and/or deductibles are paid at the time of your visit to our office. Please let us know immediately if you have a financial question or problem, as we do not wish to cause undue hardship for any of our patients. Nearly all insurance plans have patient cost-sharing requirements, called “deductibles” and “co-payments”. In addition, there may be limitations and exclusions to coverage. Please contact your health plan if you are unsure about what is covered or not covered by your insurance plan.

As a courtesy to our patients, we bill most insurance companies for you and accept assignment for the reimbursement. “Assignment” means the patient requests the insurance payment be made directly to our office. Please note that this is not payment in full; the patient is responsible for paying the designated balance. We accept cash (exact change is appreciated), checks, credit cards (Master Charge, Visa, American Express and Discover) and money orders for payment. All self-pay patients (those with no medical insurance) are required to pay at the time of the visit. If payment cannot be made at the time of your visit, prior arrangements must be made. We charge a fee of $25 for returned checks.

The status of our contracts with individual insurance companies changes from time to time. Please check with our office to determine the current status of your insurance program.


Capital Neurological Surgeons complies with applicable Federal civil rights laws and does not discriminate on the basis or race, color, national origin, age, disability or sex.

New Patient

New Patient Paperwork
Notice of Privacy Practices
TeleMed Consent
Medication Policy
Medical Record Release
Receipts of Privacy Practices Signature

Surgery

Cervical Surgery Handout
Lumbar Fusion Handout
Lumbar Laminectomy Handout
Pituitary Handout
Dr. Chan Post-Op Instructions
Dr. Hsieh Post-Op Instructions
Dr. Hsieh Spinal Cord Stimulator Post-Op Instructions
Common Interest Disclosure Statement FSSC

© 2025 Capital Neurological Surgeons

  • Home
  • Doctors + Staff
  • Conditions We Treat
  • Policies + Forms
  • Find + Contact