General Fees for Pediatric and Adolescent Medicine

(Revised 04.18.2024)

Please correct the errors described below.
  1. We collect copayments and balances due for all visits when you check in, and this is based on the contractual agreement between you and your insurance health plan. We accept cash, checks, Visa, MasterCard and Discover Card.
  2. When appointments are missed, or cancelled with little notice, it leaves an opening that could have been used for another patient. We reserve the option to charge $30.00 (or the amount of your copay) for NO-SHOWS for all types of visits. This fee is not covered by your insurance.
  3. Document fees are assessed as follows:
    • Preschool and Kindergarten entrance forms
    • Computer-generated immunization records
  4. We charge for the following services that are not covered by your insurance:
    • Repeated requests for transfer of medical records from doctor to doctor as well as copies of records sent to parent(s) for personal use-$30.00 flat rate for a multi-page PDF, CDR. Paper copies can be requested for an additional $0.25 per page.
    • Returned check charge-$30 per check.

If you have any questions about our fees or payment policies, please feel free to speak with our Office Manager.

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