Hampden Family Practice
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Patient Information

Hospital Affiliations
New Patient Forms | Privacy Practices
Your First Appointment | Insurance & Payment Information

Hospital Affiliations

New Patient Forms

Waiting room of Hampden Family Practice

For your convenience, you can print out the following forms before your appointment. Please bring the completed forms to your first office visit. [printable page help]

Notice of Privacy Practices

Patients will be asked to sign a Patient Consent Form to consent to our Notice of Privacy Practices. This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

Your First Appointment

Please arrive early so that we can complete your initial paperwork. Also, please bring the following:

  • Patient's insurance card
  • Recent test results, x-rays, or relevant records
  • Completed new patient forms if received in advance, or be prepared to provide:
    • List of current prescriptions and/or over-the-counter medication, including dose and frequency
    • Information about patient's medical and surgical history

Insurance and Payment Information

Hampden Family Practice is a provider for Medicare and most major insurance plans, and provides insurance billing. You are responsible for co-payments or charges that are not covered by your insurance. If you have questions regarding billing or which insurance plans we accept, please contact us. Questions regarding insurance coverage and benefits should be directed to your employer or insurance company.



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Hampden Family Practice

Tel: 413.533.3912
Fax: 413.533.3299
www.hampdenfamilypractice.com
Holyoke Office
10 Hospital Drive, Suite 204
Holyoke, MA 01040
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Westfield Office
115 W. Silver St., Suite 200
Westfield, MA 01085
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