Policy on Divorce, Separation, & Custody Agreements

Please correct the errors described below.
  • We believe that such matters should not enter a child’s medical treatment.
  • The individual who is requesting the medical treatment is responsible for the payment of the medical bills. We are not a party to your divorce agreement, you are. We will collect co-pays and deductibles from the attending parent.
  • The responsibility of the bill for minors is with the parents or legal guardian. It is our policy to collect payment at the time of service from the parent, guardian or caretaker who brings the child in for the appointment.
  • The parent or guardian who COMPLETES and SIGNS our Financial Policy form will be considered the GUARANTOR REGARDLESS OF INSURANCE COVERAGE. Whichever parent or designated guardian or care-giver brings a child (children) in for care is responsible for copays at the time services are rendered as per the child’s insurance coverage. This includes, but is not limited to, copay/coinsurance/payment in full.
  • “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. If there is a dispute between the parents regarding custody, and a custody agreement has been reached, we will need to see documentation specifying the legal guardian.
  • We will not call the other parent for consent prior to treatment.
  • 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 about the patient’s care, office dates/visits and any other pertinent information relevant to the care of the child.
  • We reserve the right to charge an administrative fee for copying records.
  • Should the issues that come between parents become disruptive to our organization or impede the care of the child (children), we reserve the right to discharge the patient from further treatment.

Your message will be encrypted.