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White Rose Surgical Associates, The care you deserve and the diligence you expect
Prior to Your Visit

We want to make every patient visit a pleasant and efficient experience.  To help us reach this goal, please bring the following information with you for your appointment.

Photo Identification:
For security purposes, we require you to bring a valid driver's license or a current photo ID to every appointment.

Insurance Card/Billing Information:
Be sure to bring your insurance identification card to each appointment.  As a courtesy to our patients, we will bill your insurance company. The practice cannot predict or guarantee what part of our services will be covered by your insurance plan. The patient is responsible to know the rules of their health plan. Based on your insurance or plan benefit coverage, it may be necessary to collect a deposit/co-pay at the time of each visit.  Please contact your carrier prior to your visit to obtain complete benefit coverage information. 
We accept cash, personal checks, debit cards, MasterCard, Discover and Visa.

Authorization/Referral:
If you are enrolled in a managed care plan, your insurance company may require you to obtain a referral or authorization from your primary care physician before your office visit or surgery.  If we do not receive your referral in advance of your visit, you will be financially responsible for those services.

Completion of Forms:
We will charge a minimal fee for completing disability, FMLA, and other forms.  There is also a fee for copying medical records.





Scheduling An
Appointment

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Meet Our Physicians
At White Rose we have only highly trained surgeons, so you get the best care

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Patient Forms
Click Here & fill out these forms to save time on your first visit.
Records Release Authorization
Patient Information Form
Patient Medical History Form
Financial Responsibility Form
Privacy Notice

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(717) 848-2067 | 1601 South Queen St., York,PA 17403

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