BILLING AND APPOINTMENT POLICIES
Charges are determined by the time spent as well as complexity or severity of the problem. A simple fee
schedule is available upon request. We are concerned about the cost of medical care, and appreciate
Payment is due at the time of service. Sending you bills increases your cost of care.
We accept cash, personal checks, and MasterCard/Visa. There is a charge for returned checks.
If you have private insurance, we will provide the necessary information for you to submit and be
reimbursed, but still expect payment at the time of service. We do not accept Medicaid. For Blue
Choice and Preferred Care, co-pays must be paid at the time of service, but we submit the bill toe the
company. There will be a service charge for co-pays not paid at the time of service.
If you are the custodian of the child or the child is in your custodial care and you choose to bring the
child in for care, you are responsible for payment of the bill at the time of service. This includes co-pays
for Blue Choice and Preferred Care.
We are deeply committed to providing quality care for your children. We also respect your time and
make an effort to see your child at the scheduled time.
If you are unable to keep your appointment or are going to be late, please let us know as soon as
possible. This courtesy allows us to serve other patients. Patients who do not cancel will be charged for
WELL CHILD CARE FORMS
We will generate a copy of school/day care forms at the time of your child’s well visits. Please keep this
on hand as well as a copy of your child’s immunization record to submit to school or day care as needed.
Please provide a SASE for other forms that need to be completed.
PRESCRIPTION REQUEST INFORMATION
Please have the following information available when calling the office for prescription refills:
- Child’s Name
- Date of Birth and Age (in years)
- Name of Medicine Brand or Generic Quantity
- Liquid or Pills or Chewable Refills
- Needed Name,
- Address, Phone number, and Fax number of Pharmacy Phone
- Phone number to reach you