HOMEPAGE ABOUT DR. HOLTZ SERVICES AND PROCEDURES FAQs STAFF, PRACTICE POLICIES AND FORMS
STAFF, PRACTICE POLICIES AND FORMS

Staff

Diane Hickey: Practice Manager
Dana Fisher, CMA: Senior Medical Assistant
Lisa McTigue: Medical Assistant/Technical Specialist

 
HIPPA Policy:
This is a federal law which deals with patient privacy. Our staff is trained to respect your protected and confidential health care information. A copy of our policy is available in the office.

Payment Policy:
Payment is expected at the time of the visit. Checks, Visa, MasterCard and American Express credit cards are accepted. Insurance forms are submitted electronically for all patient encounters.

Missed Appointments/ Physicals:
Dr. Holtz stresses preventative care and asks all patients to have an annual physical exam.
Our office does not "double book" appointments in an effort to respect your time and keep waiting times to a minimum.

An appointment time has been allocated to you, and is not available for other patients.  A change of appointment must be re-scheduled with our office at least one week prior to your appointment.  We require 24 hours advance notice of all cancellations.  A charge of $50.00 will be incurred if an appointment is not cancelled within 24 hours advance notice.  Reminder calls are a courtesy, it is your responsibility to remember your appointment.  Extraordinary circumstances can be discussed with the Practice Manager

New Patients Under Age 65:
Prior to the first visit, patients should complete the following forms and bring them to the appointment. Please click on the following links to print the forms - , , and .

New Patients Age 65 or Older:
Forms for new patients 65 and older are more comprehensive and should also be completed before the appointment. Please click on the following links to print the forms - , , , ,  and .

Established Patients Age 65 or Older:
Established patients please print and complete form and bring with you at the time of your physical. Please click on the following link to print the form - 

First Appointment:
Please bring completed forms (see above) and your insurance cards. In addition, bring any medical records you would like our physicians to review, a medication list and vaccination records.

Contact Us:
Atkins Medical Plaza
1500 Pleasant Valley Way, Suite 205
West Orange, New Jersey 07052
Our office is at the intersection of Northfield Ave and Pleasant Valley Way in the Atkins Medical Plaza (NOT THE ATKINS-KENT BLDG ON 101 OLD SHORT HILLS RD)
to see the map
Phone: (973) 669-9797
Fax: (973) 669-9756
   
2017 Howard Holtz MD - All Rights Reserved