- If you are unable to keep an appointment, we require 24 hour notice. There is a charge of $25.00 for all Office Visit "No Show" and a $50.00 charge for all Check-up "No Show" visits.

- If you are more than 15 minutes late for your appointment, it may be necessary to reschedule.

- A $50.00 fee will be charged for any checks returned for insufficient funds. This will not be billed to your insurance and is your responsibility.

Designated Alternate Guardians may accompany patients for acute visits only and must comply with all office policies and procedures.  


Patients who are on ADD/ADHD/DEPRESSION medications or any medication that is considered "controlled" can only receive these prescriptions in certain intervals. Your child must be seen every 30 days when initially starting medications until they become stable on the medication, then they must be seen every three months for continued refills in addition to their annual wellness check-up.

We will be running KASPER reports on your child as required by law and we are required to perform random urine drug screens.


- It is your responsibility to understand your benefit plan with regards to covered services, (including well exams and immunizations), participating laboratories and referral requirements.

- All applicable deductibles, co-insurance and co-pays ARE DUE AT THE TIME OF SERVICE.

- Self-Pay patients are expected to pay for services IN FULL AT THE TIME OF SERVICE.

- For all scheduled non-emergent appointments, patient due balances MUST BE PAID PRIOR TO YOUR VISIT.



- It is your responsibility to know if a written referral or authorization is required to see specialists, whether pre-authorization is required prior to a procedure, and what services are covered.

- A 3-5 business day notice is required for all non-emergent referrals and specialty follow-up appointments.

- It is your responsibility to know if a selected specialist participates in your plan.

- It is the sole responsibility of the parent, guardian, or designated alternate guardian bringing the child in for services to pay all co-pays, deductibles or balances at the time of service and to provide a current copy of the child's insurance card. Failure to do so may result in rescheduling. In situations involving divorce, custody arrangements or court ordered financial agreements, it is the parents'/legal guardians' obligation to work out an agreement themselves through the court system without the inclusion of Middletown Pediatrics.