New Patient Forms
For your convenience, you may complete new patient forms in advance. Please select and print from the options below, fill them out completely and bring them with you to your appointment. If you are not able to complete the forms before your visit, please allow time for completion in the office before you see the doctor. Below are new patient forms in English and Spanish.
Please arrive 30 minutes prior to your scheduled appointment time with your completed new patient forms/account update forms, insurance card and your photo id.
If you are bringing in a foster child, we will need you to provide a copy of the Notice to Provider form from CPS. To eliminate additional costs to you as well as duplicated testing on your child, please provide our office with copies of any recent blood test results. If any recent x-rays/CT scans have been done please have those IMAGES burned onto a CD.
Copayments and account balances are due at time of check in. It is the parents’ responsibility to know your insurance benefits and coverage amounts. If you are unsure of your coverage please check with your insurance.
If your insurance requires a PCP referral or insurance prior authorization number, it is the parent’s responsibility to ensure that one is on file with our office to avoid additional fees that may accrue without this referral or prior authorization.
We understand that unforeseen situations may arise that could cause appointment time conflicts. We kindly request a 24 hour advance notice of appointment cancellations to avoid a $75 “no-show” fee being accrued onto your child’s account. Repeated appointment no-shows will result in your dismissal from our practice.
Please note: We DO NOT allow pets into the clinic. Some patients suffer with severe animal allergies. We appreciate your cooperation.
We DO NOT allow any video or audio recording.