Well Child Visits

Type NA if the question does not apply to you.

Your insurance may cover well checkups at 100%, but a separate copay and deductible may apply if an additional service is provided.
During your child’s annual well checkup our physicians discuss (with you or your child) issues of normal growth, development and wellness.
They will review family, medical and social history, perform a complete physical exam and order any recommended periodic screening tests.
Your child may have other significant and separate health issues, for example (asthma, migraines, allergies, behavioral, etc) or new acute illnesses that you may want to discuss with your physician on the same day as your checkup. If time is allowed, our doctors are willing to discuss these specific concerns or illnesses at that time so you do not have to schedule another appointment.
This may require a separate office visit charge and copayments/deductible will apply.
If you have any questions please do not hesitate to ask


E-Signature

Please sign electronically below.

Your browser does not support the signature


Click submit and you hereby give consent to sign this document electronically.

Sending data