New Patient Registration Forms:
Records Release Form (One per family)
Registration Form (one per child)
No Show Policy (one per family)
Hippa Form (one per family)
Family History Form (One per child)
Fax Completed Paperwork to:
Please~ fax a copy of current insurance card
(we will ask for this at every visit)
We will also need~ valid driver's license
to scan to chart at the first visit
If your child is un-insured(Self-Pay)
we will work with you.
Let us know on your paperwork.
We accept all BCBS, AETNA, CIGNA, United Health, Tricare Standard & Prime, Medicaid, & Health Choice.
If you have another type of insurance coverage, please call our office to see if we are in network with your insurance.
If you are a new patient please:
print, complete & fax all these forms to us at:
To set up any type of appt. we will need all forms prior to adding your child to the schedule.
We would be happy to answer any questions.