Forms & Policies
Printable Office Forms
Prior to your appointment, the forms listed below can be printed for your convenience. Completing forms beforehand will streamline your visit. If you elect not to complete these forms ahead of time, please arrive 15 minutes prior to your scheduled time. (You may download Adobe Reader for free at www.adobe.com.)
New Patient Forms
Behavioral Health Forms
Well Check Forms
Office Policies
Antibiotic Policy
We strive to minimize antibiotic overuse by educating families on proper use and adhering to evidence-based guidelines for responsible prescribing. Since many illnesses are viral and don't require antibiotics, our pediatricians explain alternative treatments and emphasize the importance of natural healing when appropriate.
Furthermore, the provider will never prescribe antibiotics over the phone, as we believe in conducting proper assessments before doing so. Antibiotics are prescribed only when necessary and appropriate, ensuring patient well-being while mitigating the risks of antibiotic resistance and unnecessary side effects.
Appointment Policy
We respect everyone's time and kindly ask that you arrive 5 minutes early for your appointment. While we understand delays happen, late arrivals may need to reschedule to keep us on schedule.
Missed or canceled appointments without 24-hour notice may incur a fee, as they impact our clinicians, staff, and other patients.
Financial Policy
Optimum Medical, LLC is in network with all the major insurance carriers. Optimum Medical, LLC will directly bill your insurance for services rendered to your children. However, please remember that insurance is not a substitute for payment. It is your responsibility to pay any copayments and deductibles required by your insurance policy, as well as any balance not covered under your insurance policy. We are required to charge you for any balance not covered by your policy, and we will forward the necessary invoices to you after your account has been reconciled by your insurance company.
I authorize release of any medical information necessary to determine liability for payment and to allow Optimum Medical LLC to obtain reimbursement of any claim. I request that payment of authorized benefits be made in my child's name. I understand that I am financially responsible for all charges not ocvered by any insurance policy. I hereby authorize Optimum Medical, LLC to release all information necessary to secure such payment.
Privacy Policy HIPAA
Technology Policy
Our practice values efficiency by utilizing technology. We encourage you to visit our website, register for our patient portal, and use automated reminders for appointments and routine care or immunizations when available.
Vaccine Policy
The health and well-being of your children are our top priorities. We firmly support the expert guidance and recommendations provided by leading health authorities, including the American Academy of Pediatrics (AAP), the Centers for Disease Control and Prevention (CDC), and the Advisory Committee on Immunization Practices (ACIP). As such, our vaccine policy aligns with the evidence-based immunization schedule developed by these organizations.
We believe:
- Vaccines save lives. Immunizations have been proven to prevent serious illnesses, reduce the spread of contagious diseases, and protect vulnerable populations.
- Vaccines are safe. Extensive research and rigorous safety standards ensure that vaccines are both effective and secure for children and young adults.
- Vaccines protect communities. By vaccinating according to the recommended schedule, we help prevent outbreaks and protect individuals who cannot be immunized, such as infants too young for certain vaccines or those with certain medical conditions.
Our Policy Highlights:
- Recommended Schedule: We follow the immunization schedule endorsed by the AAP and ACIP because it has been carefully developed to provide the best protection at the most appropriate times.
- Evidence-Based Approach: Our recommendations are grounded in the latest medical research and data, reflecting a strong consensus among pediatric and public health experts.
- Transparent Communication: We are always available to discuss any questions or concerns about vaccines and are committed to providing clear, respectful information about the benefits and potential risks.
We understand that deciding how to protect your child’s health is one of the most important decisions you’ll make. By following this policy, we aim to ensure that every child in our care has the opportunity to grow up healthy, safe, and protected against preventable diseases.
