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Upon the completion of each visit, you are requested to stop at the Bookkeeping Desk for an itemized statement of services rendered. This is the times to be certain that all charges are clearly explained and that they are fully understood. You are given a time of service receipt or insurance receipt upon request.
1. Release of any medical information necessary to process this claim. I permit a copy of this authorization to be used in the place of the original.
As pediatric health care providers our highest priority is to protect the health and well-being of your children and our community. We believe that routine childhood immunizations are crucial in meeting this goal. Vaccines are one of the most helpful interventions in the history of modern medicine.