For our patients
Patient Information
At The Pediatric Care Center, we've tried to streamline the healthcare process and make it more straightforward. To aid in this, our website includes the medical forms, policies and pediatric resources our patients need.
Painless paperwork
Downloadable Patient Forms
We are happy to provide our patient forms for convenient download on your home computer. Please print and complete the forms below, and bring them with you to your child's appointment. Questions about which forms you need? Please call our office at (860) 589-4501 and our courteous staff will assist you in preparing for your child's first visit.
Patient Demographic Forms
School Release Forms
Other Forms
ADHD Forms
School / Communication Forms
You will need Adobe Acrobat Reader to view PDF files.
Health insurance
Insurance & Billing
The Pediatric Care Center wants you to get the most out of your health insurance plan. One of the best ways to do so is to review your insurance plan carefully, so that you have a clear understanding of your and your child's health insurance benefits. This will arm you with the information you need to be an effective partner with our office in managing your healthcare costs.
Health Insurance Plan Participation
Insurance plans vary widely in the amount they pay for office visits, laboratory tests and procedures. Most insurance companies have a toll-free number on subscribers' cards for help with questions about coverage.
We participate with most insurance plans. Your insurance coverage and benefits are a contract between you and your insurance company. Each plan has different benefits for you as well as different financial obligations. Not all insurance policies cover all services. It is your responsibility to check with your insurance company to determine covered benefits. We are required to file with your primary carrier only. It is your responsibility to file charges with any secondary insurance carriers for reimbursement.
We accept most insurance plans including:
- Medicaid or Husky
- Anthem
- Aetna
- Blue Cross and Blue Shield
- Connecticare
- Cigna
- United health Care
- Multiplan
- Health Net
- Tricare
If your plan is not listed please contact the office to confirm that we accept it.
Our office will contact insurance providers and cooperate with them to help you receive your maximum insurance benefits. We participate in most health insurance plans offered in the Bristol, CT, area. If you have a health insurance plan in which we do not participate, we will provide you with a completed claim form so that you can file for your benefits.
Billing, Deductibles & Co-payments
Payment is expected at the time of service. This includes co-pays, co-insurance, and deductibles. Failure to produce payment at check-in may result in your appointment being rescheduled.
Some insurance plans do not pay for preventive health care, including physical exams. If you discover that your insurance company has rejected a claim based on your coverage, we cannot change the coding of the service performed.
Feel free to contact our office if you have further questions about our health insurance and billing policies.
Know what to expect
Practice Policies
You can find important information regarding our practice's policies and procedures below. Please carefully review this information to become familiar with our policies, so you will be aware of them and know what to expect.
After Hours
For most office visits we encourage you to make an appointment. However we always strive to see our patients the same day for sick visits. We have an on call service and there is always a pediatrician available to assist you. Simply call our office number and you will be connected to the on-call doctor that will be happy to assist you. Remember if you have a life threatening emergency, call 911 immediately.
Appointments
We understand that sometimes circumstances prevent you from keeping your scheduled appointment. If that happens, please notify our office in advance. Our scheduling coordinators will do their best to promptly reschedule your appointment.
Insurance and Billing
Please call us, for information specific to your insurance company and plan.
Payment Options
We accept checks, cash or credit cards. We also offer a flexible payment plan. Please see our Financial Coordinator for details. We are happy to file insurance claims for your reimbursement as long as you are free to choose your own pediatrician.
Feel free to contact our office if you have further questions about any of our policies.
Our commitment to prevention
Vaccine Schedule Policy
At The Pediatric Care Center, serving families in Bristol and Southington, CT, your child's health and safety come first. Vaccines are one of the most important tools we have to protect children from serious, sometimes life-threatening infections.
Our providers follow the American Academy of Pediatrics (AAP) recommended immunization schedules for all patients. These schedules are based on years of research and are reviewed regularly by pediatricians, infectious-disease specialists, and public-health experts.
Our Practice Policy on Vaccine Schedules
To provide consistent, high-quality care for every family we serve, The Pediatric Care Center has adopted the following vaccine policy:
- We follow the AAP recommended immunization schedule for all patients.
- We do not offer delayed or alternative vaccine schedules.
- A medical exception may be made only when your child's healthcare provider determines that a vaccine should be postponed or avoided due to a medical condition.
This page is for educational purposes only and does not replace professional medical advice. Always talk with your child's healthcare provider about vaccine recommendations, timing, and any specific medical questions.
Questions?
We're here to help
Contact us for more patient information, or schedule your appointment online through our secure patient portal.