COVID-19 Questionnaire

Polina Kaloyanova, M.D., P.A.

     Patient Portal 

This notice describes Polina Kaloyanova, MD, PA Practice billing policies and procedures. Please review it carefully.
All co-payment, co-insurance, deductible and outstanding balance are due at the time of service.
We bill only patient’s primary insurance carrier. We do not bill secondary and/or tertiary insurance carriers and patient is responsible for all charges not covered by primary insurance carrier.
Patient/Guarantor is responsible for all charges insurance carrier denies or does not cover.
Outstanding balances not paid promptly are subject to third party collections and/or legal procedures.
If insurance carrier has not responded to a claim within sixty days, practice reserves the right to formally transfer all associated liability for the claim to the patient/guarantor.
Additional fees as return check fee, document preparation fee, medical record release fee, missed appointment fee, late appointment cancelation fee, etc. may apply.

This notice describes Polina Kaloyanova, MD, PA Practice policies and procedures related to patient portal access and features. Please review it carefully.
DO NOT use Portal to communicate if there is an emergency
How Secure Patient Portals Work
A secure web portal is a kind of webpage that uses encryption to keep unauthorized persons from reading communications, information, or attachments. Secure messages and information can only be read by someone who knows the right password or pass-phrase to log in to the portal site.
Proper Subject Matter:
- Lab results, appointment reminders or requests, routine follow-up questions, Billing inquiries, etc.
- Sensitive subject matter will not be provided over the portal (HIV, mental health, work excuses, disability applications, etc.).
- We do not refill narcotics/stimulants through this site.
- Please be concise when typing a message.
Current functionality of Patient Portal:
- Secure messaging for non-urgent needs.
- View lab results.
- View and print your personal health record.
- Viewing of selected health information (allergies, medications, current problems, past medical history).

    *Note - You can request changes or make additions to your health record, medication lists, etc. but this will not change your permanent record without our review of the information.

- Referral Requests (referral will be made at the provider’s discretion, appointment may be necessary).
- Appointment requests.
- Billing questions and viewing of statements.
- Update your demographic information (i.e. address, phone number, pharmacy, emergency contact, primary care provider-PCP, Employer).
Response Time: - We will do our best to respond to email inquires within 1 business day, but no later than 3 business days after receipt. If there is an urgent matter, please call our office during business phones hours (9:00 am – 5:00 pm). In an emergency please call 911.
How to Use Patient Portal
1. Request access.
2. Review, sign, and agree to the policies and authorization form you will be provided.
3. Bring in or mail the completed form (it will become part of your medical chart).
4. Visit our homepage at, click the Patient Portal link.
5. Use the assigned temporary login and password. You’ll be asked to change your password when you log in for the first time.
The Texas Medical Board requires that we inform you that:
1. All internet communication with our staff is required by the Texas Medical Board to be recorded in your medical record.
2. Staff members other than your physician will be involved in receiving your messages, and routing them to the doctor, nurse, or front desk as necessary.
3. Our hours of operation are 9 am – 5 pm Monday to Friday. We encourage you to use the web site at any time, however messages are held for us until we return the next business day. Messages are typically handled within 1 business day. If your doctor is out of the office that day, your request may be handled by the doctor on call, or held until your doctor returns to the office. If you do not get a response within 1 business day, please call our office as necessary.

If you have any questions about this our policies please contact office manager at (469) 694-8777.

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