Patient Forms

physical examination servicesIf you are visiting Allen’s Family Practice Clinic of Ponchatoula for the first time, for your convenience, we offer our required medical forms for you to print and complete before your visit.

Patient Registration Form
Medical History Form Page 1
Medical History Form Page 2
Notice of Privacy Practices

Fees, Billing and Insurance
The goal of Allen’s Family Practice of Ponchatoula is to deliver the highest quality medical care to our patients in the most efficient and effective manner. To do this, we must run an efficient office from a business perspective. Below is a brief summary of our office policies concerning payment of fees:

  • Private Insurance: Payment is due at the time of service for all office charges. After your visit, you will receive an invoice detailing the services performed during your visit, the associated charges and the diagnosis. The invoice contains all the information needed to file with your insurance. We also require a copy of your insurance card. For hospitalization, we allow 30 days for your insurance to provide payment. After this time, we will request payment of charges by you.
  • HMO/PPO Patients: If you belong to an HMO or PPO, please inform the receptionist upon your arrival. You will be required to make to co-payment at the time of your visit.
  • Medicare: We are participating providers in the Medicare program. If you have Medicare and supplemental policy, we will be happy to process your paperwork. However, you will be responsible for paying your deductible and any non-covered charges. For your convenience, we also accept cash, checks, Visa or MasterCard.
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Allen’s Family Practice Clinic of Ponchatoula
105 E. Oak St., Ponchatoula, LA 70454

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Contact Information

Allen’s Family Practice Clinic of Ponchatoula

105 E. Oak St.
Ponchatoula, LA 70454

Phone: 985-386-6198

Business Hours:
Monday-Thursday 8:30 a.m.-5 p.m.  Friday 8:30 a.m. - 3 p.m.

For emergencies during regular hours, please call the office. After hours, on weekends and on holidays, the doctor on call may be reached through North Oaks Medical Center at 985-345-2700.

We accept Visa. We accept MasterCard.

Most Insurances Accepted