New Patient Paperwork & Forms

To get a head start on your new patient paperwork, contact our office and we will send you a link to our online intake forms. You may also fill out the below New Patient Packet and email to info@premierpluspediatrics.com or print them and bring to your appointment with you.

» Download the SPANISH New Patient Packet

» Download the ADHD Vanderbilt Assessment Form

Patient Portal

Sign up and use our patient portal to communicate with our office!

Notice of Privacy Practices

The Notice of Privacy Practices describes the types of uses and disclosures of my protected health information (PHI) that will occur in your family’s treatment, payment of bills, or in the performance of health care operations of Premier Plus Pediatrics, PLLC. The Notice of Privacy Practices for Premier Plus Pediatrics, PLLC is also provided at the front desk. This Notice of Privacy Practices also describes your family’s rights and Premier Plus Pediatrics, PLLC duties with respect to your family’s protected health information. Questions? Email info@premierpluspediatrics.com.

Patient Orientation & Financial Policy

Appointments:

• • • If you are late for your appointment, you may be asked to see another provider or reschedule.
    • If you are unable to keep your appointment, we ask that you kindly call the office 24 hours in advance to cancel.
    • Any scheduled appointment that results in a missed appointment will result in a $25.00 missed appointment fee. A missed appointment is any appointment that is missed or not cancelled within 24 hours.
    • We cannot see a minor patient without a parent or other responsible adult present.
    • When your child turns 18 years of age, they are considered an adult and we cannot release any information without their written consent.

Insurance/Fees:

• • • We accept most private insurances, Medicaid, cash, check, and credit card for payment.
    • Co-pays are due at the time of visit, deductible amounts can be set up as payment plans, and any balances from previous visits are due at the time of service.
    • Please verify preventive care benefits with your insurance company including limitation, exclusions, and vaccine coverage.
    • During your wellness visit if another problem or diagnosis is discovered, discussed, and treated there may be an additional charge.
    • You must present your insurance card at each visit and update your personal information (address, phone number, etc.) as soon as there is a change.
    • Uninsured patients: please see the Self-Pay section below.

Self-pay Patients:

• • • • Estimated charges for your visit with one of our providers will be determined at the time of checkout.
      • If there are any additional charges based on your type of visit you will be sent a statement for additional payment.
      • If you have any questions, please call our office.

Emergencies/Urgent:

• • • You will be seen in our office by a provider that is available or a clinical staff member.
    • You will be seen within 24-48 hours of calling with conditions such as high fever, animal bite, severe pain, etc.
    • If the provider feels the hospital ER is more appropriate, i.e. severe trauma, severe bleeding, seizures, chest pains, shortness of breath, etc., they will direct you to the nearest appropriate facility.

After-Hours:

• • • • We have a provider on call, 24 hours a day, to provide emergency and urgent medical needs. Please call the office at 830-491-5019 and follow instructions given.
      • In South Texas region, non-urgent medical questions can be answered by calling 210-22-NURSE

Referrals:

• • • • Please allow 7-10 business days for a routine referral to be processed.
      • If your insurance requires a referral to see a specialist, Premier Plus Pediatrics must be listed as your PCP and you must be up to date on your well child appointments.

ADHD or Mental Health Visits:

• • • • These visits must be at least every 3 months once the patient is stable on medication.
      • While starting and changing medication, you must follow the providers requested follow up instructions.
      • When requesting refills for controlled substances (ADHD medications), please request at least one week prior to running out of medication as these medications may require a prior authorization from the insurer.
      • Prior to setting a new appointment for ADHD, we require the ADHD Vanderbilt Assessment Form to be filled out by the child’s parent/guardian and teachers.