Salud Pediatrics adheres to the CDC’s & the AAP vaccination schedule. The practice does not accept patient whose parents refuse to vaccinate their children according to AAP & CDC recommended vaccination schedule.
If insurance benefits cannot be determined, I understand that payment is required in full at the time of service. In some circumstances, I may have the option to put a credit card or debit card on hold until proof of insurance is determined.
I authorize Salud Pediatrics to keep my credit card on file (See CCOF Agreement for details).
I understand my account will be charged $25 for NSF/Returned checks.
If my child is not accompanied by a legal guardian, written authorization must be provided before health services can be rendered. I also agree to be available by telephone in the event that the physician needs to contact me.
I have read the parent agreement. I have clear expectations of what the practice requires of me as a parent. In addition to providing consent, I understand that Non-compliance with this policy may result in a dismissal of Salud Pediatrics.