Forms and Policies
New Patient Forms
- Important Information
- Patient Information
- Patient Questionnaire
- Privacy and Administration Practices
- Authorization to obtain previous Health Information
Immunization Schedule
- We provide both state and private immunizations.
- Birth to 6 years of age
- 7 to 18 years of age
Policies
Prescription Refill
Please allow up to 3 business days for prescription refills. For ease, please provide the office with the following information upon calling:
Completing Forms
Please allow 48-72 business hours to allow staff to complete any forms.
"No Call, No Show" Policy
If anything arises that may cause a cancellation, call the appropriate office to inform the staff. In the situation that a no show occurs, the patient will be charged $25.00. After two no shows, the office will discharge the patient from the practice.
Please allow up to 3 business days for prescription refills. For ease, please provide the office with the following information upon calling:
- Name and relationship to child
- Child's name and date of birth
- Name and medication
- Name and phone number of pharmacy
- Contact phone number
Completing Forms
Please allow 48-72 business hours to allow staff to complete any forms.
"No Call, No Show" Policy
If anything arises that may cause a cancellation, call the appropriate office to inform the staff. In the situation that a no show occurs, the patient will be charged $25.00. After two no shows, the office will discharge the patient from the practice.
