DUE TO THE INCREASINGLY HIGH VOLUME AND COST FOR SUPPLIES, MAILING AND PERSONNEL, THE BELOW FEES WILL BE IN EFFECT AS OF APRIL 14, 2007.
SHOT RECORDS - Your 1st shot record will be given to you at no cost, any additional copies will be a $5.00 charge. Please keep your original record. Your child will need a copy when entering school or college. There is no fee when a card is brought in to be updated.
PAYMENT HISTORY - A summary of your account, (for all children linked to the same guarantor), will be available once a year at no charge. Any additional requests will be a $5.00 fee.
COPAYS/BALANCES - Are due at the time of service. There will be a $10.00 fee for any copay or balance not paid on the day of service by 5:00pm.
RELEASE OF RECORDS - Your 1st copy of your child's medical records are given to you at no cost, thereafter a $20.00 fee will apply. There will be no charge for records requested directly by your insurance company or by a specialist that we have requested to see your child. Records will not be faxed. You can pick up your records or have them mailed.
There is $5.00 mailing fee for any record.
FMLA/MEDICAL FORMS - There is $10.00 fee for each child or each form that needs to be completed. Please make sure to have the employee requesting FMLA sign the appropriate pages so that we may forward it to your work via fax. Please make sure to bring any physical/sports forms at the time of your exam. There is no charge if completed at this time.
NO SHOWS - A $25.00 fee will be charged when a scheduled appointment is not canceled or re-scheduled ONE HOUR prior to the appointment time. Consultations not canceled or re-scheduled TWENTY FOUR hours prior to the schedule time will be charged $50.00.
*ALL OF THE ABOVE RECORDS WILL BE PREPARED WITHIN 7-10 DAYS UPON RECEIPT OR PAYMENT. RECORDS FOR PATIENTS THAT HAVE NOT BEEN TO OUR OFFICE IN OVER 3 YEARS MAY TAKE AN ADDITIONAL 5 DAYS TO PROCESS. |
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