OFFICE POLICIES & FORMS

Our Policies
  • We understand that it is hard to predict when your child will get sick, which is why we will always take walk-ins as long as our schedule allows. Please feel free to give us a call to schedule a same day appointment to minimize wait times.
     

  • If you call and leave a message for a doctor during office hours, please be patient. The doctor will return your call by the end of the work day.

  • It is the patient’s responsibility to understand and know their insurance terms of coverage including, but not limited to eligibility, PCP assignment, deductibles, copays, co-insurances, number of allowed well child visits per year, etc.
     

  • Patients will be responsible for all non-covered services or services applied to the insurance deductible designated by your insurance as “Patient Responsibility” (ex. in-house lab, diagnostics labs, hearing screenings, vision screenings, etc.).
     

  • Payment of your copay is expected at the time of service. This is require by your insurance. We accept cash, credit card, HSA, and FSA.
     

  • Please give us at least one to two weeks for all forms, sometimes less and sometimes more depending on the time of year. We DO NOT accept or send forms via fax or email as that is a HIPAA violation. If you cannot drop off a form in person, you may choose to mail to any of our locations. If you do not wish to pick up a form in person, you can provide us with a self-addressed and stamped envelope in which we will return the form to you. We will complete up to three forms free of charge per calendar year. Each additional form will incur a $10 fee.

  • Please allow at least 24 hour notice if you need a prescription refill or referral. If it is not a refill, your child will be need to be seen by one of our physicians. Please note you can always purchase certain medications such as Tylenol, Motrin, Benadryl, Claritin, Zyrtec, Hydrocortisone, and their generics over the counter without a doctor’s prescription.

Forms
New patients must call the office to schedule an appointment and must be accompanied to their first appointment by either parent or a legal guardian with legal documentation. To expedite the registration process, please print and complete the forms below prior to arriving at the office. Please also bring previous vaccine records, any pertinent or outstanding medical history, insurance card, pharmacy phone number, and parent's photo ID. If your child is a newborn, please bring discharge papers and the newborn screening pink slip.
PARENTAL CONSENT FORM
PATIENT DEMOGRAPHICS
FINANCIAL &
OFFICE POLICY
NYU Health Information Exchange Consent
HIPAA