This form is only for general inquiries NOT related to patient care or scheduling. If you are a patient requiring assistance, please call our office. Salem Chest Specialists, P.A. 3001 Lyndhurst Avenue Winston-Salem, NC 27103 Phone: (336) 765-0383 Fax: (336) 768-1737 Southeastern Sleep Disorders Center, LLC 2928 Maplewood Avenue - Suite 102 Winston-Salem, NC 27103 Phone: (336) 659-9431 Fax: (336) 659-9432 Southeastern Research Center, LLC 2932 Lyndhurst Avenue - Suite 110 Winston-Salem, NC 27103 Phone: (336) 659-8414 Fax: (336) 765-3160 Name * First Name Last Name Phone Number * Email Address * Subject * Message * OFFICE HOURS Monday - Thursday: 8:30am - 5:00pm Friday: 8:30am - 1:00pm CONTACT Phone: 336.765.0383 Fax: 336.768.1737 OUR ADDRESS 3001 Lyndhurst Ave. Winston-Salem, NC 27103 HOMESALEM CHESTSLEEP CENTERCLINICAL RESEARCHCONTACT PRIVACY STATMENT TERMS 2017 © Salem Chest Specialists | Website Design by Rotanz Design

FAQs WHY AM I ASKED TO ARRIVE EARLY FOR MY APPOINTMENT? We need to verify your insurance and information when you check in at every visit. Additionally, that allows time for us to review your medications, obtain vital signs, gather necessary information about your medical history, and complete breathing tests your doctor has ordered. WHY IS MY COPAY DUE AT CHECKIN? If your insurance plan requires a copay for a specialist office, we are contractually obligated by your insurance company to collect this at your visit any time you are scheduled to see one of our providers. If you do not have your copay, you may be asked to reschedule. WHAT HAPPENS WHEN MY PROVIDER ORDERS A SCAN OR PROCEDURE TO BE PERFORMED? Our staff will contact your insurance company to obtain a prior authorization. Sometimes this requires that they review your records to make their determination, and depending on the insurance company that may take several days. Once we have the authorization number, our staff will send your referral to the imaging center of your choice, and they will call you to schedule an appointment. WHY AM I UNABLE TO MAKE MY NEXT APPOINTMENT WHEN I CHECK OUT? We currently have our schedule open 4-6 weeks in advance, as it is subject to change based on the needs of our providers’ hospital coverage. WHERE IS MY APPOINTMENT? Daytime appointments are scheduled either in our main office at 3001 Lyndhurst Ave or our satellite office across the street at 2928 Maplewood Ave. The location will be listed on your appointment letter. You can also hear the address listed in the reminder phone call you will receive two business days prior to your appointment. QUICK LINKS Patient Portal Novant Health Forsyth Medical Center American Lung Association Society of Critical Care Medicine American Academy of Sleep Medicine American Thoracic Society North Carolina Thoracic Society American College of Chest Physicians OFFICE HOURS Monday - Thursday: 8:30am - 5:00pm Friday: 8:30am - 1:00pm CONTACT Phone: 336.765.0383 Fax: 336.768.1737 OUR ADDRESS 3001 Lyndhurst Ave. Winston-Salem, NC 27103 HOMESALEM CHESTSLEEP CENTERCLINICAL RESEARCHCONTACT PRIVACY STATMENT TERMS 2017 © Salem Chest Specialists | Website Design by Rotanz Design