Forms

For your convenience and to reduce the amount of time you spend completing the paperwork during your visit, please click on the links below to download and print the forms.

 

Divorce Policy

We believe that divorce, separation and custody agreements should not enter into a child's medical treatment.  The parent who is requesting the medical treatment is individually responsible for the payment of the medical bills.  We are not a party to your divorce agreement; we will collect co-pays and deductibles from the attending parent.

"Joint Custody" means that each parent has equal access to the child's medical record.  Without a court order, we will not stop either parent from looking at their child's chart or obtaining their child's test results.  In the circumstances of joint custody, we will not call the other parent for consent prior to treatment or to inform the non present parent of the assessment and/or plan of care, if any.  Again, we will discuss with the accompanying parent, information pertinent to the child's history and/or present exam.  It is the responsibility of the parents to communicate with each other.

We reserve the right to charge an administrative fee for copying records should the requests become excessive.

Should issues between the parents become disruptive to our medical practice, we reserve the right to discharge a family from our care and responsibility and will do so promptly.