Policies & Forms

Prompt Appointments for Quality Pediatric Care in Alpharetta


Patients are seen by appointment only. We realize that children sometimes need immediate attention, we are happy to accommodate sick visits as soon as possible. We request a call to our office for scheduling.

Parents or guardians (who are listed in the registration form) need to be present with the children while we provide care.


Billing Policies

Billing Policies

We LOVE delivering quality pediatric and genetics care and enjoy the personal relationships we have with our patients and families. We must however recover charges for these services so we can continue to survive and thrive. This way we can continue to always “be there”, whenever you need us. Below is a list of our billing policies that will help us continue to deliver the highest quality medical care that you deserve.

  • We accept most insurance carriers (Aetna, Amerigroup, Beech Street, Blue Cross Blue Shield, Core Source, Coventry, Cigna, Guardian, Meritain, Peachstate, Tricare, United Health, Wellcare). If you have any questions about coverage of your specific insurance carrier, please do call our office. This is especially important if you are a Genetics patient. Not all carriers seem to recognize us In-Network,
  • For your convenience, we accept cash, personal checks, VISA, MasterCard, American Express, and Discover cards
  • Co-payments, coinsurances, deductibles, and any charges for non-insurance covered services must be paid at the time of service.
  • If you are unable to provide us with proof of coverage, full payment of your visit will be necessary at the time service is rendered.
  • If you do not have insurance or are on a plan in which we do not participate, full payment is required at the time of your visit. We will supply any necessary information for you to file your insurance claim.
  • You may charge your balance to your credit card. We encourage families to authorize Pediatrics and Genetics to charge a credit card for balances that appear on their children’s accounts. Authorization forms are available by clicking here .Simply print the form out, fill in your information and mail it, fax it, or bring it with you to your next appointment.
  • Let us know if your family is under significant financial hardship. Payment plans can be arranged if necessary. We want to be sure that your family receives the care you need and deserve.
  • We must have updated confirmation of your insurance and identifying information at every visit. It is your responsibility to let us know of any changes in insurance data, addresses, telephone numbers, etc. and to assure your insurance policy registered with Pediatrics and Genetics remains updated and active.
  • We will bill the insurance company you designate for the services we provide. If we do not receive payment from your insurance company within 60 days, the balance transfers to your responsibility. You will be notified about any unpaid amounts
  • If balances not covered by insurance remain unpaid by you after 60 days notification, we may need to reschedule routine checkup appointments. Additional recovery fee of $12.25 will be added to your account balance due longer than 60 days. Delinquent accounts may also be subject to collection fees.
  • We may charge a nominal fee of $20 for completing complex forms. Our staff will advise you of this if this is the case with any request you make.
  • Any calls made to the doctor's personal phone which are not emergencies will incur a charge of $15.

Cancellations / Late Arrivals / Walk-Ins

  • Please call / email us 24 hours in advance if unable to keep your appointment. No Shows and same day Cancellations will be billed $25 to discourage disruption of patient care in the clinic.
  • If you are 15 minutes late for your appointment, our staff will ask the doctor to help determine when best to see your child. You may be worked into the schedule with a wait, you may be given the next available appointment, or you may be asked to reschedule. This will help us balance the needs of all of our patients.
  • Walk-in patients will also be asked to wait for the next available appointment, except in the case of an emergency.

New Patients

We ask all new patients to please arrive at least fifteen minutes in advance to fill out all new patient paperwork. Please bring all relevant paperwork from your previous pediatrician, including immunization records and laboratory test results. Download our new patient registration form


Registration Form

This form provides patient and insurance information. New patients are requested to complete this form and bring it for your first visit. This will expedite processing.

Medical Records Transfer

Request release of medical records into our clinic. For patients transferring from other practices to our clinic.

Medical Records Release

Request release of medical records to another physician or clinic.

Patient Referral

Please use this for Physicians or Providers that would like to refer patients to our clinic.

Clinic HIPAA Policy

Provides information on clinic policies on handling patient records to comply with HIPAA


For referrals, please complete the Referral Form and advise the referring physician that our office will be contacting them.