Looking for a form?

Here are some of the forms you may need to fill out and bring with you on your next visit. All patient information is confidential.

New Patient – English7.45 MB
New Patient – Español7.62 MB
Practice Policies – English54.83 KB
Practice Policies – Español121.11 KB
Questionnaire54.78 KB
Privacy Practices47.99 KB
Early and Periodic Screening, Diagnostic, and Treatment36.86 KB
Healthy Beginnings1.28 MB
Receipt of Privacy Notice18.86 KB
Records Release48.37 KB
Treatment Authorization61.73 KB
Vaccine Program119.73 KB

New & Current Patients

Our office takes pride in the comprehensive well being of our patients. Well child examinations are done during the first weeks of life, 1 month, 2 months, 4 months, 6 months, 9 months, 12 months, 15 months, 18 months, 24 months then yearly.
Please bring the following to your child’s first visit: Parent/Guardian photo ID, child’s insurance card, vaccination card.

Helpful Hints

Always bring your insurance card and your child’s vaccination card to each appointment. Know your benefits, deductible and your co-pay amount.

*You may save time by printing and filling out the Patient Registration Forms at home and bringing them to the office.

Request for copies of Medical Records:

Copies of your medical records can be sent to another physician once a release of records form is signed. However, if you wish to pick up your records we will gladly make copies for you. A fee of $25.00 per chart will be assessed.

Office Policy

Smoking is prohibited inside our office. No food or drink, with the exception of baby bottles. Please be respectful and limit the number of people who accompany you to the office as seating is limited.

If you suspect that your child has chicken pox, please inform the office staff prior to coming in so that a nurse or provider can assess your child prior to them entering our facility so as not to expose others.

After Hour Emergencies:

If your child is experiencing a life-threatening event, please call 911. If you have an urgent matter arise after hours, please dial (520) 836-2424 and follow the prompts. Please note that calls for appointments, to reschedule appointments or questions regarding referrals are not appropriate after hour calls. Please call the office the next business day for our staff to handle these requests.

Missed or cancelled appointments

Appointments that you make are specifically for you and your child. If you are unable to make your appointment as scheduled, please be courteous and call the office so that we are able to see another child needing medical care in their place. If you call less than 24 hours to cancel your child’s appointment we cannot fill that space as we are under the impression that your child will be at their scheduled appointment.

If you are going to be more than fifteen minutes late for your child’s appointment, please be courteous and contact our office to see if we will be able to accommodate your late arrival. If not, we will be happy to reschedule your appointment.

Insurance

For all patients that are on plans in which we are participating providers, your co pay and/or deductible amount will be due at the time of service. Our office will gladly file your insurance; however, our relationship is with you and not your carrier.

The parent/guardian is financially responsible for all charges incurred in your child’s care and treatment. Payment for any amount not covered after insurance reimbursement is due upon receipt of your first statement. Please consult with your insurance company (member services department) regarding your specific benefits and coverage.

*We accept cash, checks and credit cards, (Visa, MasterCard and Discover).

Looking for a form?