Legal Information

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Legal Guardian

Except in limited circumstances, such as in the case of an emancipated minor, both parents are financially responsible for their child(ren)’s care.  When we provide services, we bill the appropriate insurance carrier.  However, both parents remain responsible for any unpaid amount.

Although divorced parents may have a divorce decree that established their financial responsibilities with respect to each other, we are not a party to the decree.  Accordingly, we require the parent/adult accompanying the child for treatment to accept responsibility for any payment due at the time of service

Minor Patients

Minor Patients (Under 18) cannot be seen without a parent or legal guardian unless prior written permission is on file indicating persons with permission for the child’s care, including permission to sign for consent to give vaccines.  Exceptions to this are made for any patient who wishes to see the physician without a parent for privacy reason.  For all services rendered to minor patients, we look to adult accompanying the patient for payment of services rendered including co-pay, deductible and/or co-insurance.

Missed Appointments

It is our policy to charge $25.00 for missed appointments.  Three missed appointments without notification within a reasonable amount of time may result in termination from the practice.  You will have 30 days from the time you receive the 3rd notice to find another pediatrician for your child(ren).  Please call us as early as possible if you know you will need to cancel or re-schedule your appointment.

HIPAA Notice of Privacy Practice

This notice describes how medical information about you may be used and disclosed and how you can get access to this information.

If you have further questions, please call our office and ask to speak to the privacy officer.

HIPAA Notice of Privacy Practice