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· Previous medical records, including x-rays or other studies, related to your child’s urologic condition.
· List of any questions you have relating to your child’s condition.
· Completed Patient Registration Form.
· Completed Patient Questionnaire.
· Completed Acknowledgement Form stating that our Notice of Privacy Practices Policy has been
reviewed and agreed to.
· Your Drivers License.
· Your child’s insurance card(s).
· Cash, check, money order, or credit card to pay your share of the cost of the visit. Newborn Circumcisions must be paid by cash or credit card only (no checks).
· A referral from your child’s Pediatrician/Family Practitioner, if required by your insurance company.
· Written authorization or custody paperwork, if the patient is under 18 years old and will not be accompanied by a
legal custodian.
· Prior to your appointment, you should review the following information:
· Financial Policy
· Participating Insurance List
If you need to cancel your child’s appointment, please do so at least 24 hours in advance.
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Questions and Prescription Refills
If you have any questions about your child's care or need their prescription refilled, please call our office between 8 AM and 5 PM Monday through Friday.
Emergencies
One of our doctors is available after hours to handle situations that require immediate attention. Call our answering service at (727) 562-6859 and they will contact the doctor on call. In case of a life-threatening emergency, please call 911.
Medical Records Release
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