Registration

It is the policy of this practice that all patients be registered upon arrival.

Registration requires:

• Signing in the patient’s name
• Verification of demographics
• Proof & presentation of insurance card at each visit
• Payment of copay if applicable.
• Payment of outstanding balances or making a
• payment arrangement

ALSO SEE: Forms
(Registration Form, Easy Pay Consent Form)

Returned Checks
It is the policy of the practice that a $35.00 return check fee is charged to patients who have written checks that are unable to be cashed by the bank.  The patient is still responsible for the original amount for which the check was written.

School/Camp Forms
It is the policy of the practice to charge $10.00 per form.  Forms will require five business days to be completed.  There is a fee of $15.00 for an express or same-day service.  Upon receipt of payment, completed forms can be picked up or mailed if a self-addressed stamped envelope is provided.  Forms cannot be faxed.  

April through September is our busy “form season.” To avoid last minute rushes, please learn our policy and submit forms to us as soon as you receive them.

Release of Records
It is the policy of the practice to charge the following for the release of medical records:

• $15.00 for 1 child
  
• 30.00 for 2 children
  
• 40.00 for 3 children or more

The request must be submitted to us in writing, if the patient is leaving the practice.  If records are released for other reasons, then a HIPAA request must be completed.  The release of records will require at least 5 business days to be completed.