Patient Forms & Policies

Welcome to Caring for Kids Pediatrics, PA, specializing in the care of your children.

Click here to download a Zip file with all forms

Policy Highlights

Your Appointment: Please arrive before your scheduled appointment to allow time to complete any required registration forms. Bring your insurance card to every appointment. We will verify your insurance and personal information at each visit. You will be allowed a ten (10) minute grace period for being late after which you will be given the opportunity to reschedule or wait for cancellations.

Canceled Appointments: If you are unable to keep your scheduled appointment, please call our office within 24 hours to reschedule. Doing so enables us to use your appointment slot for another patient. This policy benefits you and others. Unfortunately, if you fail to keep an appointment, without calling to cancel, you will be considered a "No Show". Three Repeated "No Show" appointments will result in dismissal from the clinic.

Medications: Your prescriptions will be written at the time of your office visit. Refill request may be made through your pharmacy. Please be aware that for certain illnesses your refill may require an appointment. We will not prescribe any medications based on telephone consults. If this is an emergency medication please follow our Emergency Care instructions.

Medical Records: We will provide a copy of your medical records upon request. You will need to sign a letter of release prior to pick-up. Please allow 3-5 business days for us to copy your records. If you wish for your records to be mailed, there may be an associated fee to cover the mailing costs. You may be charged for additional copies of your medical record.

Disability/Insurance, FMLA, Daycare, Copy of Immunizations, and Sports Physical Forms: There will be a charge of $10.00-$30.00 for the completion of medical forms. You will be informed of the exact cost prior to completion of each form. Payment is due at the time of pick up. Please allow 7-10 days for the completion of these forms. If you would like these forms mailed to you or your insurance company, payment will be due prior to mailing. Certain forms cannot be faxed.

Preventative Well Child Exam: Includes a general exam, vital signs as well as a vision and hearing screening. Additionally, depending on age, hemoglobin/lead may be tested along with a developmental screening known as MCHAT. Any other additional findings, complaints and or issues addressed during a Preventative Well Child Exam will be subject to an office visit. Co-payments and/or deductible as required by insurance coding and billing guidelines will apply.

In This Section