YOU’LL NEED THESE AT YOUR APPOINTMENT

When you need to schedule an appointment for your child you will need the following things:

Your Child’s Insurance/ Medicaid cardPlease bring your child’s insurance or Medicaid card with you to your appointments, so your bill can be processed.

Your Child’s Insurance/ Medicaid card

Please bring your child’s insurance or Medicaid card with you to your appointments, so your bill can be processed.

Co-payment or prepaymentIf your child’s health plan has a co-payment or pre-payment requirement, please bring your payment with you.

Co-payment or prepayment

If your child’s health plan has a co-payment or pre-payment requirement, please bring your payment with you.

Medications ListBring a list of your current prescriptions, over-the-counter drugs, vitamins or supplements, as well as a list of known drug allergies.

Medications List

Bring a list of your current prescriptions, over-the-counter drugs, vitamins or supplements, as well as a list of known drug allergies.

Any Notes about Health ConcernsSome patients find it helpful to write a few notes about the symptoms their child is experiencing as well as any other health concerns.

Any Notes about Health Concerns

Some patients find it helpful to write a few notes about the symptoms their child is experiencing as well as any other health concerns.

Your Child’s Name

Your Child’s Name

Your Child’s Date of Birth & Social Security number

Your Child’s Date of Birth & Social Security number

Reason for your Child’s appointment

Reason for your Child’s appointment

Any Previous Medical Records**Your child’s new pediatrician will want medical records of previous care. If you need help transferring records, ask the staff when you call to schedule your appointment.

Any Previous Medical Records*

*Your child’s new pediatrician will want medical records of previous care. If you need help transferring records, ask the staff when you call to schedule your appointment.