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^ times. Remember each missed appointment takes up two appointments: the
one missed and the new rescheduled appointment

1. If an initial appointment made with our office is not kept, it is our experience
^ that the family has changed it's mind and has decided to go elsewhere. This

appointment will not be rescheduled with this practice. Future appointments for
other family members will be cancelled.

m 2. The first time an established patient/family misses an appointment, it will be

rescheduled for a later date. Sick visits will be rescheduled at a later time or

date, depending on the severity of the illness.

3. If a second appointment is missed by a family member, the parents will be
notified of our policy. The policy allows only three misses. The appointment will

be rescheduled.

^ 4. Onthe third miss, a letter will be sent to the parent stating that due to a failure

to keep appointments, they will be asked to seek care elsewhere. All future
appointments will be cancelled for the family.

^ Please call the office at least 24 hours in advance if you need to cancel or

change an appointment. You can leave a message after hours with the
answering service. Also, call the office if you are going to be late for an
appointment. It will help us coordinate our schedule. Call us as soon as you

^ realize you have missed an appointment.

The decision to enforce this policy has come about because of the volume of
missed appointments and the strain it puts on our appointment system. We feel
that our patients deserve the best care possible. We hope that you understand
^ our policy and will help us provide this high level of care to you and your family.

Prescription Refiiis:

^ • Prescription refills are processed Mon through Friday ONLY.

• Please allow at least 24 hours for the prescription refill process to be
completed. More time may be needed if a weekend or holiday is involved.

• If you need a refill for a medication that does not require a written

^ prescription you should call your pharmacy. They will contact us for a new

prescription if there are no refills left.
• If the medication you're requesting requires a written prescription call our

office. You will be asked to leave your child's name (please spell last
name), date of birth, your provider's name, the drug to be refilled and the
dose and whether you want us to mail it or if you want to pick it up. Please
speak slowly and clearly.

m Billing:

Our office will submit your claims to your insurance company for you, however it
is you who contract with the insurance company. We are doing the billing as a
free service for you. We must be provided with your insurance card. The claims

^ address, policy and group numbers are needed, along with the subscriber's

social security number.

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