Payment Policy Form

These forms need to be completed before the initial office visit and certain information should be updated at every visit. The first form provides us valuable information about your child's health. The second provides us not only with insurance information, but it also provides information should we need to contact you or your child's pediatrician. The third and fourth forms allow us to treat your child, tell us how to contact you with test results and explain the payment policy. Please feel free to print these forms, fill them out at home and bring them with you to the appointment.

Authorization for Release of Health Information Form
This form is necessary should you need a copy of your child's medical record.