Kids - baby

Office Visit Form

Office Visit Form   is required If your child is: “New Patient” (regardless of the reason for the visit), or “Established Patient” being seen for health check. Please note that this form typically takes 20 minutes to finish and is specific to your child’s age, so make sure to select the correct form that matches the exact age of your child. Please fill out and submit the form online by (latest) 12 noon one day prior to your child’s appointment to avoid cancellation.

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Confirming an appointment

Please confirm your scheduled appointment by (latest) 12 noon one day prior to your child’s appointment. All unconfirmed appointment will be rescheduled. You may confirm your appointment by Calling our office or Online.

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Cancellation Policy

If you are unable to keep your appointment for any reason, Please notify us at least one day (24 hours) prior to appointment, or you will be charged a “no show fee” ($20) which will not be covered by your health insurance. The “no show fee” must be paid prior to being scheduled for another appointmentWe will no longer give appointment to patient with repeated no shows. You may cancel appointment by Calling our office or Online.

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Financial Policy

  • Self-pay patients are expected to pay before they are seen by the physician.

  • Co-payments are the patient’s responsibility and will be due before seeing the Doctor.

  • We will submit claims (for service provided) to insurance companies directly. Any remaining balance is the patient’s responsibility and must be paid by the patient.

  • We accept cash, checks, MasterCard, American Express, Visa and Discover cards.

  • There will be a $25.00 fee for returned checks.