[{“hide”:”on”,”content”:”
rn “,”button_text”:””,”button_url”:””,”image”:”https://circlecarecenter.org/wp-content/uploads/2023/10/IMG-4251-768×1024.jpg”,”color”:””,”background_image”:””,”parallax_background”:”0″,”overlay_color”:””,”overlay_opacity”:””,”additional_classes”:”hero__body-wrap”,”anchor_link”:””,”type”:”internal_hero”},{“hide”:”on”,”content”:”
Patient Forms
rnFor your convenience, we have supplied our general patient forms below. You can use the links provided and submit them online ahead of your next appointment; or if you prefer, paper copies can be provided to you at the time of your appointment.rnrn “,”image”:”https://circlecarecenter.org/wp-content/uploads/2023/02/IMG-1295-scaled.jpg”,”color”:””,”background_image”:””,”parallax_background”:”0″,”overlay_color”:””,”overlay_opacity”:””,”additional_classes”:”cc__background-secondary-purple”,”anchor_link”:”patient-forms”,”type”:”two_column_image_text”},{“heading”:”Norwalk New Patient Intake Forms (Please fill out all 6 forms before your first appointment)”,”form_blocks”:[{“title”:”Patient Registration”,”content”:””,”button_text”:”CLICK HERE”,”button_url”:”https://hipaa.jotform.com/230034546503042 “},{“title”:”Patient Health Questionnaire”,”content”:””,”button_text”:”CLICK HERE”,”button_url”:”https://hipaa.jotform.com/230035565057149 “},{“title”:”Notice of HIPAA Privacy Practices”,”content”:””,”button_text”:”CLICK HERE”,”button_url”:”https://form.jotform.com/230794634624057″},{“title”:”Authorized Contact Medical Release Form”,”content”:””,”button_text”:”CLICK HERE”,”button_url”:”https://form.jotform.com/260116577264155″,”button_new_window”:”on”},{“title”:”Release for Medical Records (Entering CCC – Norwalk)”,”content”:””,”button_text”:”CLICK HERE”,”button_url”:”https://hipaa.jotform.com/build/251604061205039″},{“title”:”Review of Systems – Norwalk”,”content”:””,”button_text”:”CLICK HERE”,”button_url”:”https://form.jotform.com/240535169345054″}],”color”:””,”background_image”:””,”parallax_background”:”0″,”overlay_color”:””,”overlay_opacity”:””,”additional_classes”:”cc__background-secondary-purple”,”anchor_link”:””,”type”:”forms”},{“heading”:”Request an Appointment”,”form_blocks”:[{“title”:”Request an Appointment in Norwalk”,”content”:””,”button_text”:”CLICK HERE”,”button_url”:”https://form.jotform.com/222296199905063″}],”color”:””,”background_image”:””,”parallax_background”:”0″,”overlay_color”:””,”overlay_opacity”:””,”additional_classes”:””,”anchor_link”:”request”,”type”:”forms”},{“content”:”We accept additional insurance plans not listed here. If you do not see your carrier listed here, give us a call to confirm that your insurance will be accepted,rnrn(203) 852-9525.rnrn rn
Appointment Cancellation Policy
rnYou must call 24 hours prior to your scheduled appointment time to avoid a mandatory $25 cancellation fee.”,”image”:”https://circlecarecenter.org/wp-content/uploads/2023/01/iStock-509176180-scaled.jpg”,”color”:””,”background_image”:””,”parallax_background”:”0″,”overlay_color”:””,”overlay_opacity”:””,”additional_classes”:”cc__column-reverse”,”anchor_link”:””,”type”:”two_column_image_text”},{“content”:”
“,”color”:””,”background_image”:””,”parallax_background”:”0″,”overlay_color”:””,”overlay_opacity”:””,”additional_classes”:””,”anchor_link”:””,”type”:”content-area”},{“heading”:”Additional Information”,”form_blocks”:[{“title”:”Patient Rights”,”content”:””,”button_text”:”CLICK HERE”,”button_url”:”https://circlecarecenter.org/patients-rights/”,”button_new_window”:”on”},{“title”:”Patient Complaint Form”,”content”:””,”button_text”:”CLICK HERE”,”button_url”:”https://hipaa.jotform.com/230396401477053″},{“title”:”Release for Medical Records (Leaving CCC – Norwalk)”,”content”:””,”button_text”:”CLICK HERE”,”button_url”:”https://form.jotform.com/230603769422152 “},{“title”:”Medicare Wellness Health Risk Assessment”,”content”:”Only for patients on Medicare”,”button_text”:”CLICK HERE”,”button_url”:”https://form.jotform.com/242334291116045″}],”color”:””,”background_image”:””,”parallax_background”:”0″,”overlay_color”:””,”overlay_opacity”:””,”additional_classes”:”cc__background-secondary-purple cc__remove-top-padding”,”anchor_link”:””,”type”:”forms”},{“hide”:”on”,”content”:”
Insurance Information
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Payment and Insurance
rn rnrnCircle Care Center participates with most local and national insurance plans. However, it is your responsibility to understand whether your insurance has limits on the doctors you can see or the services you may receive.rnrn rnrnDepending on your insurance coverage, you may be responsible for co-payments, co-insurance, or other deductible amounts. These payments are due at the time of your visit.rnrn rnrnPlease contact our billing office, (203) 852-9525, or call your insurance carrier should you have any questions.”,”image”:”https://circlecarecenter.org/wp-content/uploads/2023/01/iStock-1348146435-scaled.jpg”,”callout_content”:”
Accepted Insurance Plans include:
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- Aetna
- Anthem/Blue Cross Blue Shield
- Cigna
- ConnectiCareu00a0
- Medicaid
- Medicare
- Oxford
- United Health Care
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rn t
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“,”color”:””,”background_image”:””,”parallax_background”:”0″,”overlay_color”:””,”overlay_opacity”:””,”additional_classes”:”cc__background-secondary-purple”,”anchor_link”:”insurance”,”type”:”callout_section”},{“hide”:”on”,”content”:”
Patient Assistance Program
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Circle Care Center offers patient assistance to ensure our patients can access affordable healthcare services, regardless of insurance status. CCCu2019s Patient Assistance fund can help cover out-of-pocket costs for patients seeking sexual health services who are underinsured or uninsured. Financial assistance is provided to cover a patientu2019s costs for copays, lab fees, prescriptions, transportation, and more. This program only provides financial assistance for services provided at Circle Care Center.
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Are you having trouble affording your care at Circle Care Center? Fill out our Patient Assistance Fund Application today and a CCC staff person will be in touch to see what we can do to help.
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Additionally, we have a separate program that can assist with costs associated with a PrEP prescription for HIV prevention. To find out more about this program, go to our PrEP Grant program page.
“,”color”:””,”background_image”:””,”parallax_background”:”0″,”overlay_color”:””,”overlay_opacity”:””,”additional_classes”:””,”anchor_link”:””,”type”:”text_callout”},{“hide”:”on”,”content”:”If, for some reason, you felt that the service you received was not satisfactory, please fill out our Patient Complaint Form online. You can also call Anthony to discuss your experience at 203-852-9525. If you prefer to fill out a paper copy of the Patient Complaint Form, please email info@whcccc.org to request one.rnrn rnrnIf you feel as though you have been discriminated against, you can file a complaint directly with the U.S. Department of Health and Human Services (HHS) Office for Civil Rights by sending a letter to 200 Independence Ave, S.W., Washington, D.C. 20201; calling 1-877-696-6775; or visiting theu00a0HHS website.rnrn rnrnCircle Care Centerrnc/o Anthony Crisci, CEOrn618 West AvenuernNorwalk, CT 06850″,”image”:”https://circlecarecenter.org/wp-content/uploads/2023/01/Anthony-Crisci.jpeg”,”color”:””,”background_image”:””,”parallax_background”:”0″,”overlay_color”:””,”overlay_opacity”:””,”additional_classes”:”cc__background-secondary-purple cc__column-reverse cc__remove-top-padding”,”anchor_link”:”grievances”,”type”:”two_column_image_text”},{“hide”:”on”,”content”:””,”color”:””,”background_image”:””,”parallax_background”:”0″,”overlay_color”:””,”overlay_opacity”:””,”additional_classes”:”cc__background-secondary-purple cc__column-reverse cc__remove-top-padding”,”anchor_link”:””,”type”:”content-area”},{“hide”:”on”,”section_title”:”Local / LGBTQ / Online Resources”,”sub_title”:””,”resource_blocks”:[{“title”:”HIV/AIDS Basics”,”content”:”Basic information about HIV/AIDS, HIV prevention, and HIV testing. For those just diagnosed with HIV, find information on what to do next. Learn how to stay healthy while living with HIV”,”button_text”:”Learn More”,”button_url”:”https://www.aids.gov/hiv-aids-basics/”,”button_new_window”:”on”}],”content”:””,”color”:””,”background_image”:””,”parallax_background”:”0″,”overlay_color”:””,”overlay_opacity”:””,”additional_classes”:”cc__remove-border”,”anchor_link”:””,”type”:”resources”},{“hide”:”on”,”section_title”:””,”sub_title”:””,”resource_blocks”:[{“title”:”New Haven Pride Center”,”content”:”Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna.”,”button_text”:”Visit”,”button_url”:”google.com”}],”content”:””,”color”:””,”background_image”:””,”parallax_background”:”0″,”overlay_color”:””,”overlay_opacity”:””,”additional_classes”:”cc__remove-top-padding cc__remove-bottom-padding”,”anchor_link”:””,”type”:”resources”},{“hide”:”on”,”section_title”:””,”sub_title”:””,”resource_blocks”:[{“title”:”PrEP Watch”,”content”:”Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna.”,”button_text”:”Visit”,”button_url”:”google.com”}],”content”:””,”color”:””,”background_image”:””,”parallax_background”:”0″,”overlay_color”:””,”overlay_opacity”:””,”additional_classes”:”cc__remove-top-padding cc__remove-border”,”anchor_link”:””,”type”:”resources”}]