Patient Resources

Forms

• Contraceptive Form
• Guarantor Sheet
• Medical Records Release From Another Provider
• Medical Records Release to Patient
• Risk Assessment Form
• BellaDonna No Show Policy
• Privacy Policy

Insurance Plans

• AARP
• Aetna
• Affinity (HMO)
• Cigna
• Empire Blue Cross Blue Shield
• Empire HealthPlus Blue Shield (HMO)
• Emblem GHI
• Fidelis (HMO)
• Magnacare
• MultiPlan (PHCS)
• Medicare
• Oxford Health Plans
• The Empire Plan
• UnitedHealthCare
• UnitedHealthCare Community Plan (HMO)
• UMR
• 1199SEIU

Patients MUST call the office to verify if the doctor is in NETWORK with their specific plan. Please note that each insurance carrier has multiple plans and we are NOT in network with all plans.