Patient Forms

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Policies

We ask that you allow 3 days for routine prescription refills. You may call our office during working hours with the following information:

• * Your name and relationship to child
• * Child's name (with spelling) and date of birth
• * Name and strength of medication
• * Name of prescribing physician
• * Name and phone number of pharmacy
• * Daytime phone number for you

Please allow our staff and providers 48 hours to complete all forms requested.

We understand that occasionally you made need to cancel your appointment. Please provide us with adequate notice so that your appointment may be given to another patient. Failure to cancel your appointment within 24 hours of the scheduled appointment time is considered a no show and will subject you to a charge.

Although it is an infrequent occurrence, a patient may be terminated from the office and given 30 days to locate another medical office for their continued care. Patient termination is at the discretion of the patients’ primary care physician. Common reasons for termination include, but are not limited to, use of foul language, chronic noncompliance with recommended therapy, abusive behavior towards staff, providers, visitors or other patients.