We want your child's first visit to our clinic to go as smoothly as possible. The information on this page will help you, your child and our staff to accomplish that goal.
Please download, print and fill out the office forms available below. Bring them with you and any other medical records to your child's first appointment. This saves you the time and stress of having to fill them out in the office.
If you can't find the answers to your questions in the information below, call our clinic during office hours. Our contact information, hours and clinic address are on our Clinic Information page.
(Use this form to request medical records be sent from one doctor to another.)
(We need this form filled out for all new patients.)
(This form gives us the right to treat your child in case of emergency. Please refer to Legal above.)
(This document describes our clinic's privacy practices, please read, but not required to print out.)
If you are unable to print the forms and there is time, you may request a copy of the forms to be mailed to you so you can complete them prior to arriving at the clinic.
All of our physicians are currently accepting new patients.
We make every attempt to schedule appointments at a time that is convenient for you. Same day appointments for illnesses and injuries are usually available.
Our goal is to have your child seen by their primary doctor the majority of the time for continuity of care. On most occasions this is possible, however, since our doctors schedules vary, from time to time your child may be seen by another physician in the practice.
If you need to cancel or reschedule an appointment, please call us as soon as possible before the appointment. The sooner you call, the sooner we can reschedule your child's appointment and make that time available for another patient.
New patients are asked to arrive at least 15 minutes early to their first appointment to allow adequate time for completing the initial paperwork. You can download our registration form to save time, however, we still need to prepare the chart before your child is seen.
First Appointment Checklist
Here is a quick checklist of the items you should consider bringing to your child's first appointment:
- Completed office forms
- Medical records (either bring them or have them sent)
- Immunization records
- Notes and questions for the doctor
We respect your time and know that is valuable. Our doctors strive to see their patients at the scheduled time. However, at times, emergency situations arise that affect this. Please be understanding, next time it may be your child that we need to see immediately.
We ask that you properly supervise your child at all times. Please DO NOT leave any of your children unattended in the waiting area or exam rooms. Our staff cannot be responsible for watching your children.
At your newborns discharge from the hospital, your doctor will ask you to bring the baby to our office within a few days for a weight check. This gives new parents a chance to ask questions regarding concerns or problems and allows your doctor to check the baby's progress since leaving the hospital.
Don't forget the important step of adding your baby to your insurance plan. You must do this within 30 days from date of birth.
As pediatricians, our doctors will want to see your child at intervals recommended by the American Academy of Pediatrics. During these visits, the doctor will discuss your child's growth and development as well as relevant safety and developmental issues appropriate to your child's age. Immunizations are kept current, and an assessment is made for sports participation if your child will be engaged in any organized sports in the upcoming year.
If your child has been seen by another doctor, you may request in advance that their records be sent to us. You may download our medical records request form on this web page, or call us and we will send one to you.
Please don't forget to bring your child's immunization records to your child's first appointment.
If you are unsure what records are needed, leave that part blank on the Information to be Released within the HIPAA Authorization for Records Release form, and bring it to your appointment. You and your physician will decide together what records are needed.
We are contracted with most major insurance companies. Please check with our business office and your insurance plan to ensure that we are covered under your policy. It is the parent or guardian's responsibility to verify their child's insurance coverage. If you have an insurance change, please notify us at your child's visit. Many plans now have a "timely filing" provision in order to pay. It is critical that we receive accurate information to comply with this.
If there are two insurance policies that cover your child, please provide us with the correct information for each, including which is primary and which is secondary. If you aren't sure please check with your insurance companies. Coordination of benefits can often be challenging, but we are happy to bill your insurance plans with correct information provided.
Please bring your insurance card with you when your child has an appointment and be prepared to make any co-pay payment. For your convenience, you may pay by cash, check or credit card.
At times your child may need to see a specialist. If your doctor at University Place Pediatric Clinic has seen your child and is referring your child to a specialist, we will initiate any insurance authorization and notify you when the referral is approved by your plan. If you desire to see a specialist and haven't been directly referred by your doctor here and you are on a managed care plan, please contact our referral specialist to obtain the referral. With the exception of emergency care, you must contact us prior to your specialist visit for your insurance plan to approve and pay for the specialty care.
If you sign an advance consent to treat form, we may see your child in the event of an illness or injury where you are unable to accompany them to the office. Only a legal guardian may sign for immunizations, unless specific, written authorization is given to another individual to sign these consents. If you are not the child's parent (for example foster parents, grandparents, aunt, uncle, etc.) we must have legal documents showing that you are authorized to seek medical care.