We are happy to complete any and all forms free of charge as long as the form is brought in during a sick or well visit. If we need to pull a chart and review the record on a day that the child is not seen in the office, a fee of $10.00 will be charged per child per day for any forms that require a physician’s review and signature that are not completed during your child’s appointment. Please allow 2 business days for this form to be completed. If you need a form signed on the same day and the child is not being seen, there is a $20.00 fee.

All payments for forms must be paid in full and will be required at the time of the request and forms will not be completed until payment has been made. Please understand that charging for form completion has been an industry standard for several years. We hope that our patients understand our reluctance to charge fees for paperwork that you need for your children but charging for these services has become a necessity. If we could continue to offer these services at no charge, it would be our pleasure to do so. Unfortunately, it is no longer possible for Pediatric Affiliates to offer these ancillary services without charging a fee to our patients.

There is a minimum $25.00 fee for any letter that needs to be generated for whatever reason. Insurance companies will not pay for this charge. We do not have the secretarial ability to generate this type of correspondence, so please give us 3 to 10 business days (depending upon the length and complexity) to finalize any letter/form you may need.