Patient Information

Thank you for choosing Wentworth Health Partners Coastal Neurology Services. We want your experience with us to be welcoming and productive. Please use the information on this page to help you prepare for your appointment or to learn more. 

Forms

So that we have the most up-to-date information about you and your care needs, we may ask you to fill out paperwork before your visit. To help make the most of your time with us, please consider printing and filling out the required forms prior to your visit. You can mail, fax or bring the forms with you to your appointment.

Go To Forms

Billing & Insurance

Wentworth Health Partners will bill all participating insurers on your behalf and will also bill all secondary and tertiary insurance plans after your primary plan has made payment. We will courtesy bill any non-participating insurance one time. Any remaining balance not paid by a non-participating insurance will be your responsibility.

Co-payments are due at the time of service. Please note, should you have a previous outstanding balance with any Wentworth Health Partners provider, payment for that balance will also be requested at the time of service. If you do not have insurance, payment will be requested at time of service. All non-insured patients will receive a 10% courtesy discount.

Forms of Payment

• Personal Checks
• Credit Cards: Visa, MasterCard and Discover
• Pay Your Bill Online

Effective February 1, 2019, Wentworth Health Partners and Wentworth-Douglass Hospital will only accept credit cards and checks for patient co-payments, prepayments and outstanding balance payments. Cash payments can be made at the Financial Services Office at 121 Broadway, Dover, NH.

Financial Assistance

Wentworth-Douglass Hospital and Wentworth Health Partners work hard to make high-quality health care available, affordable and accessible to all, regardless of ability to pay. Our organization offers many financial assistance and referral programs to ensure that cost will not be a barrier to anyone in the community to receive the health care services they need. Visit the Financial Assistance page to learn more.

Full Billing & Insurance Information