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, you may print off the following forms to complete at home and bring with you 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 (use this form if all your children have the same birth mother and birth father or if all of your children are adopted)
    • Patient Registration 2 (use this form for each individual child who has a different birth mother or birth father from their siblings)
  2. Financial Policy Form
  3. Immunization Form
  4. Office Policy Form

 

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

  • Your child’s insurance card
  • Parent’s driver’s license or State ID.
  • Your child’s immunization record.
  • 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 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.