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Forms and Policies

HIPAA Letter to Parents

We keep your family's private information secure. This letter explains why we do this and how we can share information with other providers to keep your family safe and healthy. Click here to open.

Notice of Privacy Practices

Information on how health information about you (as a patient of this practice) may be used and disclosed, and how you can get access to your individually identifiable health information. Click here to open

Financial Policy

The purpose of this form is to notify you of our office policy in advance.  Please read this carefully and if you have any questions, do not hesitate to ask a member of our staff. Click here to open.

No Show Policy

When patients do not show for scheduled appointment, it deprives our practice of offering that appointment to another patient. Therefore, a $30.00 no show fee will be assessed if  24 hours notice is not given to cancel an appointment.

Form Fee

A $10.00 fee will be assessed for school/camp forms.  A $20.00 fee will be assessed for more complicated forms such as FMLA forms, disability and letters of medical necessity.  Payment must be received prior to forms being returned.  We have a 2 to 3 day turnaround time for forms.

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