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Patient On-Line RegistrationThank you for visiting our website and registering on line. Completely filing out this registration form will minimize your waiting time during your next visit to our office. Your responses to all the information contained in this form will allow our office to verify insurance benefits and eligibility, determine your financial responsibility and obtain any required prior authorization from your insurance company prior to your scheduled visit. While you are entering this information on a secure site, there are parts of this process that aren't secure. We will not use your information for any other purposes Click here for On-Line Registration
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Randy A. Birken, M.D., F.A.C.S., F.A.C.O.G. Copyright 2000-2006 Randy A. Birken, M.D., F.A.C.S.,
F.A.C.O.G. All Right
Reserved
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