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Patient Forms

Click on the links below in order to download and print the necessary forms.

  

Patient Information Form

  

Notice of Privacy Practices

  

Notice of Privacy Practices Acknowledgement Form

  

Authorization for Release of Patient Information from ZPA, PLLC

  

Authorization for Release of Patient Information to ZPA, PLLC

 

Insurance Coverage Information Form

Because it is our policy that payment is due at the time of service, you are required to pay, at minimum, any deductibles and/or coinsurances at the time of service.  If we are not contracted with your insurance company, you will be expected to pay in full.

Because your insurance company determines the amount of coverage you will receive, it is your responsibility to be aware of your benefits prior to each office visit. If you are unsure of your coverage, you need to contact your insurance company directly.

Please complete the Insurance Coverage Information Form prior to your first visit and remember to notify us at each visit of any changes to your policy.

A copy of your insurance card is necessary for us to file your claims.

Contact Information

4301 Lake Boone Trail, Suite 210
Raleigh, NC  27607

Main Office:  919.278.2041
Clinical Research:  919.719.9393
Facsimile:  919.278.2042

Automated Voicemail

If your call is answered by the Automated Voicemail please listen carefully to the list of options from which to choose.  You may enter your party's extension, and your call will be forwarded right away.  Below is a list of our current extensions.

  Emergency Calls Press 1  
  Doctor or Hospital Calls Press 2  
  Directions/Address/Fax Press 3  
  Scheduling Press 4  
  Prescription Refills Press 5  
  Clinical Research Program Press 6  
  Billing and Insurance Press 7  
  Medical Records Press 8  

 

  Dr. Michael Zarzar 111  
  Dr. Nicholas Zarzar 120  
  Dr. David Zarzar 119  
  Ms. Mary Spencer 112  
  Ms. Alice Colbert 117  
  Ms. Rhonda Qualls 393