REQUEST AN APPOINTMENT
*Unfortunately we are no longer in network Medicaid plans*
Best contact number:
Are you currently a patient of Dr. Kotz or Amanda?
Were you referred to our office by another physician?
If yes, which physician or facility referred you?
What is the primary reason for your appointment?
If you chose "Other", please explain the reason for your appointment:
We see patients in our West Ashley location Monday through Friday, and in Goose Creek on Thursdays.
At which office would you prefer to be seen?
Are you covered under a health insurance policy?
If you are not covered under a health insurance policy our self pay discount price is $95 for the office visit, which will be expected at check-in. There may be additional fees for other services rendered during your visit, for example: biopsies, injections, etc.
Primary insurance name and policy number (if applicable):
Secondary insurance name and policy number (if applicable):
If you are covered under a health insurance policy, you will be responsible for all applicable co-pays, deductibles, and/or co-insurance amounts at the time of service. You may view our Billing and Payment Policy by clicking the link at the bottom of this page.