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First Visit Forms
Before Your Appointment
- Understand Your Insurance – A simple and easy to understand primer on Insurance.
- Understanding Preventative / Well Visits – What your Insurance means by a Well visit (also what it DOES NOT cover)
- Important information to know before your Office Visit – What you must know before your Office Visit
New Patient Forms (English)
- Texas VFC Patient eligibility Screening Form (only for Uninsured patients & Government insurance like Medicaid)
- Medical Release Form for Minors Attending with a Non-Legal Guardian (Fill only if a non-legal guardian will bring the child)
To speed up your visit, please fill up and fax the forms to 972-618-3547 or scan the completed forms and email to firstname.lastname@example.org at least 48 hours before your visit.
Every insurance plan is different. Please note that understanding your insurance and paying for a service, on time, is the patient’s responsibility. Insurance companies demand that we collect copays and deductables at the time of service. What insurance instructs us to collect from you, we bill you later. In most cases, it takes up to three to four months for us to get paid. If you have a question about a bill, please contact your Insurance Company first. If you need additional assistance, please ask for our Billing Manager.
Appointment Cancellation Policy
We strive to see all patients who schedule appointments on-time. The only reason for delay is if the doctor has to visit a child in the hospital or another patient’s medical situation delays us. We will try to keep you informed if this occurs. We know things can come up in your schedule to change your appointment. Please give us 24 hour notice of a change. We are happy to reschedule your appointment and give the appointment to another sick child. Be advised that you will incur a self-pay charge if we do not receive this notice before 24 hours. Thank you for helping us to remain accessible to you and others!
Insurance Coverage of our Services
Natural Pediatrics tries to belong to as many insurance plans as possible so that we can see your child. There are many unique and new plans that are frequently changing. It is always best for you to contact your Employer or their Human Resources Department or call the number on the back of your insurance card, before your visit, for the most current information about your individual plan, to see if we are in your network, or to see if a particular service is covered.
Some plans (like HMO and Medicaid) require that you designate a Primary Care Clinic. To obtain coverage, Dr. Lata Shridharan MUST be selected as PCP. To avoid unforeseen cost, please verify with your insurance that Dr. Shridharan is your PCP, before your child’s visit.
If you need additional assistance for any of the above services or for other concerns, please ask for the Office Manager at 972-618-3547.
Por favor, imprimir, llenar-up, y llevar a los formularios completados a la oficina durante su primera visita (sólo). Si desea acelerar su visita, por favor, escanear y enviar a email@example.com
Nuevas formas Paciente (Español):
- Carta de bienvenida Paciente Nuevo
- Nuevos Derechos del Paciente, Responsabilidades y otras formas de política
- ImmTrac Consentimiento
Medicaid Formas: (sólo para el Seguro de Gobierno)