Patient Forms & Policies

Cancellation Policy

We care for many sick children. Cancelling your appointment 24 hours in advance allows us to open the appointment slot for other children.

We realize emergencies happen - they happen here as well. We ask our parents to give us appropriate notice so that we may offer the slot to others. Waiting until the day of the appointment to cancel may not leave us with enough time to help others.

Failure to cancel your appointment 24 hours in advance is called a "No Show".

No Shows are serious to a primary care medical practice. Patients that have two No Shows may be charged for the second visit. Upon a third No Show, we may dismiss the patient from our practice.

Please tell our receptionist if you have extenuating circumstances. Thank you!

Patient Forms

To save time on the day of your appointment, please fill out these forms and bring them with you:

• New Patient Questionnaire
• Pre-Natal Data Questionnnaire
• Medical Records Release - HIPAA
• Vanderbilt Parent Questionnaire
• Vanderbilt Teacher Questionnaire
• M-CHAT Survey
• M-CHAT Score Instructions
• Beck Depression Inventory
• Adolescent Health Survey
• Financial Policy

Note: These files are in PDF format. If you do not have Adobe® Reader® on your computer, you can download it for free by clicking here or on the Get Adobe Reader icon.