Specialty Forms

Sports/Physical Forms/Day Care Forms

In order to fill out regular physical forms, the child must have had a physical within the past 365 days (one year). The physical must have been within the last 6 months for sports forms. Remember it can take up to 72 hours to fill out the forms. Make sure when you drop the form off that you fill out the parent’s portion completely or we will not be able to complete the form.

Office Policies

Payment Policies, Insurance and Fees

We strive to provide quality medical care at a reasonable cost. If you have a question about any of our charges or the status of your financial obligations or insurance claims, please ask us.

For services provided in our office, we expect payment at the time the services are rendered. For your convenience, we accept cash, check or credit card. We realize that medical expenses are sometimes unforeseen and cause financial hardship. Special payment arrangements may be available under extenuating circumstances and must be approved prior to services being rendered.

Please provide us with a copy of your child’s current insurance card each time you come to our office. It is important that you keep us informed of any changes in your child’s insurance coverage. We have contracts with most insurance companies. If we have a contract with your insurance company than you are responsible to pay any charges not covered such as co-pays, co-insurance, deductibles or any non-covered service at the time of the visit.

For in-inpatient newborn hospital services, we are glad to file a claim with your insurance company. Please provide us with the necessary information to file your claim within one week from the date your child is discharged from the hospital. Please contact your insurance company immediately to add your newborn child. Some insurance companies only allow 30 days to add a newborn to your insurance policy.

It is important to remember that even though we file for you, we cannot guarantee that all services are covered. We expect payment from you if the insurance company denies the claim or has not paid the claim within 45 days.

All expenses incurred as a result of a motor vehicle accident or public liability are considered to be the personal responsibility of the guarantor. We will expect payment in full at the time services are rendered. We will provide you with the information you will need to be reimbursed.

Checks that are returned for “Insufficient Funds” will not be automatically re-deposited. A charge of $ 25.00 will be added to your account for each returned check. Payment on a returned check is expected to be made within one month from the date it was originally written to avoid any further collection action.

We reserve the right to notify you that you should seek medical care elsewhere if satisfactory arrangements cannot be established for accounts that are more than 3 months overdue.