FORMS & POLICIES
for simplifying your office experience
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| 2._new_patient_paperwork_english.pdf |
| 3._new_pt_paperwork_spanish.pdf |
| 4._refusal_to_vaccinate_english_.pdf |
| 5._refusal_to_vacinate_spanish_.pdf |
| 6._mchat.pdf |
| 7._tb_questionnaire_for_children_english.pdf |
| 8._tb_questionnaire_for_children_spanish_.pdf |
| 9._lead_questionaire_english_.pdf |
| 10._lead_questionaire_spanish.pdf |
| 11._asq_9_months_english.pdf |
| 12._asq_9_months_spanish.pdf |
| 13._asq_18_months_english_and_spanish.pdf |
| 14._asq_24_months_english_and_spanish.pdf |
| 15._asq_30_months_english_and_spanish.pdf |
| 16._asq_36_months_english_and_spanish.pdf |
| 17._asq_48_months_english_and_spanish.pdf |
Policies
First Step Pediatric Associates Policy Page
We want to welcome you to First Step Pediatric Associates, P.A. Below is a summary of our office policies, which we hope will provide you with the information necessary to make informed decisions about your child’s healthcare.
APPOINTMENTS
We want to welcome you to First Step Pediatric Associates, P.A. Below is a summary of our office policies, which we hope will provide you with the information necessary to make informed decisions about your child’s healthcare.
APPOINTMENTS
- Our office will allow a scheduled patient to arrive up to 5 minutes late. If you arrive after the 5-minute grace period, your appointment will be considered a “no-show,” you must reschedule it. Please note that a scheduled sick appointment is regarded as a “no-show” once an appointment is either missed or canceled/rescheduled within 2 (TWO) hours of the appointment. To avoid accruing a no-show, please cancel your appointment at least 2 (two) hours in advance. A well-child check appointment will be considered a no-show if the parent fails to reschedule or cancel with 24 hours advance notice.
- Our office may dismiss patients (and siblings) from our practice after two “no-show” appointments within 12 months.
- Please understand that due to the time reserved for wellness exams, our office will not permit families to schedule more than 2 (two) siblings on the same day (this is for wellness exams only).
- FSPA reserves the right to cancel or reschedule non-urgent appointments due to non-payment for outstanding balances, copays, or self-pay fees. All co-pay and self-pay fees are fully expected at the time of service. We accept the following forms of payments, which are due at the time of service: cash, Debit/Credit Cards, Health Savings Accounts, or Care Credit.
- No-show fee: First Step Pediatric Associates will charge a $25 fee for failure to keep scheduled appointments. Please call our office 24 hours before the appointment to cancel or reschedule an appointment you cannot keep. Please be aware that your insurance will not cover any no-show fees.
- For after-hours non-urgent requests, please be advised there will be a $50 processing fee for clinical review and follow-up by First Step Pediatric Associates Physicians and medical staff.
- The office is closed for all major holidays. Parents should use URGENT CARE and EMERGENCY Department for any needs during our closure.
- For inclement weather office hours, please call our office at 817-641-8800 and listen to our voicemail for updates. For urgent and emergent care when our office is closed due to inclement weather, please use URGENT CARE AND EMERGENCY CARE.
- Our office reserves the right to dismiss any patient or patient’s family from our practice for making unsubstantiated defamatory statements (whether written or spoken), harassment, aggression, yelling, insulting, or using profanity toward FSPA staff. If you are dissatisfied with our services, we take it seriously and invite you to contact our office to discuss the matter with management so that we may resolve the matter and aid in improving those services.
- A parent/guardian choosing to decline vaccinations must sign a "Refusal to Vaccinate" form to continue services with our clinic. No part of the document can be altered when signing. We reserve the right to dismiss any patients refusing to comply.
- Please remember that your child must be current on wellness exams before FSPA accommodates specific requests (letters, school forms, referrals, etc.). If your child is not up to date, FSPA may deny your request until the child’s well-check has occurred.
- Newborns--please be aware that not all plans automatically cover newborns, and patients may be asked to pay for the visit in full if our office staff cannot verify coverage for the service date.
- Well Child Exams—Please be advised that any issues discussed outside growth and development during a patient’s well check must be charted by a provider and may result in a copay and/or additional charges.
- Labs – Please be advised that your lab order or test may be sent to an outside facility for processing. Therefore, you will be billed separately by the outside lab, and a co-payment, co-insurance, or deductible may apply. If you receive a bill from an outside facility, please contact them to discuss. FSPA is not responsible for outside billing for services rendered. Most routine tests are performed on site, special tests are most often sent to an outside lab facility. Please review your insurance plans to determine the lab of choice is in network with your insurance plan.
- Insurance card—Please be advised that you will be required to present your most recent insurance card at every visit. We verify insurance benefits prior to your child's seeing our providers. Failure to update our office with correct insurance information on the date of service will result in the charges being billed to the patient. We cannot bill new insurance if it is not provided during the appointment.
- REFUNDS—For any credit balance on your account, you must request a refund from the office. They will not be automatically issued. Please allow ten business days for processing.
- COLLECTIONS—Accounts that remain unpaid will be sent to a collection agency for further collection proceedings, which may result in patients being dismissed. The account will be assessed a $25 collection fee.
- Please note that there is a $5.00 service charge for letters and a $15 service charge for documents/forms that need to be filled out by the provider. Also, after-hours charges may apply after regular business hours.
