Forms and Policies


Despite the profound changes in pediatric diagnosis and therapy in pediatric medicine as in all medicine over the many years of our practice, our attitude toward taking care of families has remained very much the same. As we have from the beginning, we make every effort to treat all our patients and their families with empathy, courtesy, an appropriate sprinkling of humor, and generally very personal care. We try to make scheduling convenient, seeing sick children the same day when desired and return daytime phone calls in a timely manner by either nurse or doctor and after-hour calls personally as well. For sick baby/child visits, we prescribe medications only when medically justified with an appropriate explanation to the parents. I even still make occasional house calls for patients in my immediate neighborhood, and often personally return phone calls when out of town.We appreciate the importance of and provide the reassurance that many childhood illnesses require while trying to also emphasize those indicators (“red flags”) in the course of an illness that might signal increased seriousness and the need to update and assure prompt re-evaluation. In summary, we try very hard to combine very current and evidence-based pediatric medicine, with the traditional closeness and communication of doctor and family that has always been such a vital component of the art of medicine.

Patient Forms

Please print and fill out these forms so we can expedite your first visit:

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WHEN COMING TO THE OFFICE FOR ANY VISIT we ask families to assist us and themselves with the following:

    • Please make an appointment rather than “just showing up.” This is necessary to minimize wait time for appointed patients.
    • If you need to cancel, we ask for 24 hours’ notice unless there are unpredictable circumstances, in which case a shorter-notice call is still helpful. This is especially important if the time has been allotted for more than one child in the family.
    • If you are a new patient or if there has been an insurance change, it is important to be sure that you have a plan with which we participate and that we are listed as the patient’s PCP. This will lessen the chance of an insurance rejection and the resulting patient responsibility for the fees of the visit.
    • If there is a change in your insurance or demographic information, let us know about it promptly.
    • For new patients, it is very helpful to have records at the initial visit, or at least the child’s immunization record and growth chart.
    • Please try to be prompt for your children’s appointments, or even earlier for a first visit or a double checkup, both of which can involve extra paperwork. If the arrival time is significantly delayed, we may have to see the patient at the next available slot in the day or re-schedule in order not to get excessively backed up or be forced to rush a visit (which we do not like to do).
    • Families should understand that co-payments should be taken care of at the time of the visit. It is also important that it be recognized that health insurance policies are contracts between the policyholder—the familes—and their insurers. There may be fees that EOB’s indicate are the family’s responsibilities, such as deductibles, and it means that just having insurance does not relieve the family of financial responsibility for services received. When needed, we are willing to make extended payment plans. This should be discussed with our billing office
    • For checkups, we generally need at least a couple of weeks’ advance notice, except in the case of newborns, whom we will see at very short notice. For “double checkups” even more advanced scheduling may be necessary.
    • We will generally see sick children the same day if this is preferred. We are happy to discuss the illness by phone to help you—and us– make this decision. These visits will not always be at the preferred time, but we do our best, and often carry the day beyond “regular hours” to do this.
    • We always welcome questions and even opinions and suggestions on our office policy. We regard it as very important to have patients that are not only well-cared for but are also happy with all the aspects of that care. Please feel comfortable to pass along your comments without reservation.