New Patient Paperwork

To get a head start on your new patient paperwork, download a PDF, print, and complete. Please be sure to bring the completed forms to your first appointment.

» Download the SPANISH New Patient Packet

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.

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:

• • • Appointments will be made according to the type of appointment needed.
    • All patients will receive access to appropriate medical care within a reasonable length of time.
    • If you are more than 15 minutes 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 incur a $25.00 missed appointment fee.
    • A missed appointment is any appointment that is missed or not canceled within 24 hours.
    • We cannot see a minor patent without a parent or other responsible adult present.
    • When your child turns 18 years of age, they are considered an adult and as such 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, deductible amounts, and any balances from previous visits are due at the time of service.
    • Please verify preventive care benefits with your insurance company including limitations, exclusions, and vaccine coverage.
    • During your wellness visit if another problem or diagnosis is discovered, discussed, and treated there may be an additional charge.
    • Uninsured patients: Please see the Self-Pay section below.
    • Present your card at each visit and update your personal information (address, phone number, etc.) as soon as there is a change.

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 the instructions given.

Self-pay Patients:

• • • • Estimated charges for your visit with one of our providers will be determined at the time of checkout.
      • You will be offered a self-pay discount if paid in full at check out.
      • If there are additional charges based on the type of visit you will be sent a statement for additional payment.
      • If you have any questions, please call our office and ask to speak with the billing department.