Forms and Policies

Payment Policies:
Full payment of deductibles, co-insurance or co-payments is expected at the time of service. Self-pay patients are expected to provide payment in full at the time of service.  Sunshine Pediatrics accepts cash, Visa, MasterCard, American Express, and Discover.  Personal checks are accepted after the first visit.  Patients must present their insurance identification card at EACH visit. Some of the insurances accepted are:  Aetna, Carefirst, NCPPO, GEHA, Cigna, and United Healthcare, to name a few.

Missed Appointments:
Missed appointments represent a cost to us, to you, and to other patients who could have been seen during your scheduled time slot.  Please call at least 24hours in advance to cancel an appointment.  There will be a $25 charge for missed appointments.

Referrals:
If your insurance contract requires a referral for consult or treatment by a specialist or for ancillary services such as physical therapy or radiology procedures, your must receive the referral from our office before seeing a specialist.  Patients are required to consult with their primary care physician prior to requesting a referral.  Except in true emergencies, you must allow five business days for our office to complete the referral.

18 month and 2 yr Well Child Visits

M-CHAT 19KB

6 month Well Child Visit and Older

Risk Assessment 17KB
Preventive Screen Questionnaire - Spanish 18KB

New Patient Forms

Medical Family History - English 35KB
Medical Family History - Spanish 39KB
Patient Registration Form 37KB
Medical Records Request 35KB