For the convenience of our patients, we provide downloadable patient medical forms to be filled out for your children before your visit
Because of the increasing amount of non-clinical work that is involved in caring for your children, we have needed to start charging for some services that are not covered by insurance. We will try to complete as much paperwork (such as school forms, immunization records, sports forms, camp forms) and non-covered services as we can at the time of your child’s well check-up appointment so that these additional charges can be minimized.
Should you prefer not to be ‘nickeled and dimed’, you may choose a yearly flat fee of $200 per child within the first 30 days of the year that will cover most of these services.
All Patients: Please read carefully our “Office and Financial Policies” statement.
Please note that we need a copy of your insurance card at each visit.
Please download these PDF forms, fill them in completely and bring them to your first appointment.
Power of Attorney
Office and Financial Policies
Notice of Privacy Practices
Credit Card Authorization
If any information has changed (insurance, address, email) since your last visit, please complete a new ‘Family Demographics’ and bring it with you to your next visit. Also, every year we need you to sign the “office and financial policies” which may change from time to time.
Office & Financial Policies
Please click on these links to download and fill out the Vanderbilt questionnaires (one for the parents and two separate questionnaires for two teachers who know your child’s classroom behaviors best). Everyone should fill the forms out separately. Please have these filled out prior to the first office visit, and bring them to your visit.