Leestma Healthcare Patient Forms


We accept most health insurance plans. We recommend the patient check with their insurance company to determine if they are eligible to be seen by our providers. At this time, we do not accept any Indiana Medicaid policies.

Patient Portal

What to Expect at Your Appointment

Before Your Appointment

  • When you call to make your appointment, verify with the scheduler that the office takes your insurance.
  • When making the appointment provide a few details about your concern so that a proper length of time can be scheduled.
  • Be ready to provide information about diseases that run in your family and describe current and past health problems and treatments. Write it all down if that helps and bring past medical records and test results.
  • Make a list of the medications you are taking (or bring in the bottles) including the doses and frequency of prescription and over-the-counter medications, as well as herbs, supplements and vitamins.
  • Arrive 15 minutes early for your first visit to complete new patient paperwork.
  • Bring your insurance cards and picture ID to all office visits.

During Your Appointment

  • Share your symptoms, relevant health history and the list of medications that you take. Don’t forget about your emotional health; it influences your physical health.
  • Our providers take a team approach to your health. Work with the medical assistants and providers to develop a treatment plan.

Before Leaving Your Appointment

  • Find out when you should return for another visit and clarify the next step. Schedule a follow-up appointment if necessary.
  • Ask if you need to watch for certain warning signs for your condition, ask when you should be concerned and at what point you need to call in.
  • If you have received a new prescription, ask about possible side effects. Ask how to reach the doctor if you have questions or concerns.
  • Make sure all your questions are answered! Don’t leave if you are uncertain about your diagnosis or treatment plan.

Office Policies

Front Desk

  • Co-payment is due at the time of visit, before you see a provider.
  • Registration forms must be updated annually. This may seem inconvenient, however sending the incorrect information will cause your claims to be delayed and could be more problematic in the future.
  • We accept most insurance. It is the patient’s responsibility to contact their insurance company to determine if they are eligible to be seen by our providers.
  • Patient must provide a valid form of identification in order to pick up any documentation or medication.

Medication Refills

  • Patients should contact their pharmacy and request a refill.
  • Patient must be seen every 1-2 months for narcotics, and 3-6 months for maintenance medications.
  • Medication refills will not be called in on the weekends or after business hours.


  • When patient statements are sent, we ask that you respond within 30 days. If you are unable to pay in full please call our billing department to make payment arrangements.
  • All patients with be billed after 30 days; If the patient has an outstanding balance, the balance needs to be paid prior to their next visit.
  • When discussing a payment schedule, the account should be settled in full within 3 months with no less than 1/3 payment each month.
  • To avoid collections, consistent monthly payments must be made.


  • A nurse will discuss labs over the phone with the patient. If there are additional questions, an appointment must be made.
  • It takes 3-5 business days for the lab results to be received and reviewed by the physician.


  • If you are unable to keep your appointment, please cancel 24 hours prior to avoid a possible fee.

Minor Patients

  • In order for us to give your child the best care possible, it is essential that a parent or legal guardian accompany your child to office visits. If this is not possible, we need a letter signed and dated by the parent/legal guardian giving us permission to provide the child with care.