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Demographics and Billing Policy

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We ask that all of our existing patients complete this form, as it will be used to update your child's chart with the most recent demographic information. This is necessary to activate new billing features in existing MyChart accounts, and to grant full MyChart access to new users. MyChart is a portal in which parents are able to view their children's medical and billing records with our clinic. 


Our billing policy, updated March 11, 2024, ultimately states that we will be collecting outstanding balances upon checking in for visits, and will be collecting deductible amounts upfront for any Sick, Follow Up, and Consult visits. We ask that you please complete all fields to show your understanding of our new policies. 

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