Policies

To ensure that parents have a clear understanding of our healthcare operations and of their financial responsibilities, we have created the following policies. Please read these thoroughly before your child’s appointment.  We are happy to answer any questions you may have.


New Patient Forms

For your convenience, we have provided these typable PDF forms for you to complete at home and print off to bring to your appointment.

Note: In order to view or print these forms you will need Adobe Acrobat Reader installed. Click here to download it.

  1. Patient Registration Form
    • Patient Registration 1 (For children with the same birth mother and birth father OR who are all adopted)
    • Patient Registration 2 (Please use this individual registration form for children with a different birth mother or father)
  2. Financial Policy Form
  3. Office Policies & Vaccine Policy Forms

 

Please also bring the following items to your child’s first appointment:

  • Your child’s insurance card (the actual card or a printed paper copy of both sides)
  • Parent’s driver’s license or State ID
  • Your child’s immunization record (printed paper copy)
  • Medications your child takes regularly (if medication must be kept refrigerated, then a list of medications and dosages is acceptable).

Record Release Form

Records Release Form  To protect our patient’s privacy we require this typable PDF authorization to be completed prior to releasing any medical records.  Please complete all sections of the form and submit to our office by mail, fax or in person. All applicable fees must be paid at the time of your request.  Please allow 2 weeks for records to be prepared. This form may also be used for patients transferring in to our office. Please complete the form and submit to your child's previous doctor.