Patient Forms & Downloads
Questions about which forms you might need? Please call our office and our staff will assist you in preparing for your child’s visit.
New Patient Forms
- To expedite your first appointment, please download and print our new patient forms, fill them out ahead of time, and bring them with you to the appointment.
- New Patient Registration
- HIPAA Privacy Policies
- Portal Registration
- Portal Registration (18+ years)
Authorization Forms
Authorization Forms (18+ Years)
- These forms are for patients 18 years or older.
- Authorization for Release of Medical Information
- Consent for Release of Medical Information
- Portal Registration
Well Child Exam Handouts
- Bright Futures HandoutsFor Parents
- Bright Futures HandoutsFor Patients
School Forms
Billing & Insurance
Arvada Pediatric Associates is dedicated to providing quality, accessible, and cost effective health care services to our patients. Understanding your financial responsibilities is an essential part of your child’s care. If you have any questions concerning these policies, please contact our billing office.
Your Responsibilities
- To know the limits and coverage of your particular health insurance policy.
- To show your insurance cards to us at each visit.
- To pay any copays at the time of service.
- To provide updated address, phone numbers, and insurance information to our office.
Our billing staff will do their best to assist you with insurance questions. However, if you have questions about your coverage, it is best to check with your specific insurance company.
Insurance
To be as accessible as possible to the families in our community, we accept most insurances. Please contact your insurance carrier to verify that Arvada Pediatric Associates is in your network, and to verify your benefits and coverage.
Copayments
Copays will be collected at the time of your visit. Please check with your insurance company for the requirements and provisions of your policy to determine the dollar amount of your co-payment prior to your appointment.
Payment Methods
For your convenience, we can also handle your payments on your account at the registration desk. We accept cash, check, debit cards and major credit cards.
Self-Pay
If you are not covered by a medical insurance plan, payment is expected at the time services are provided. Payment in full at the time of service may be eligible for a discount.
Billing Questions
If you have questions regarding your account please contact our billing office at 303-467-9548.
Office Visit Policies
We require an appointment for your child to be seen.
Mutual Respect of Time
Our providers strive to stay on schedule. Although there can be emergency situations that prevent us from running on time, we pledge to provide quality care with minimal wait time to the best of our ability.
To respect your time, we make the following requests:
- Please check-in online if appropriate and arrive at least ten minutes prior to your appointment time. Please have your photo ID, insurance card and needed forms readily available upon arrival.
- If you are running late, please call the office. We may be able to accommodate you with advance notice.
- We require a minimum of a one hour notice for cancellations.
“No Show” Policy
A “no show” is when you fail to arrive for your scheduled appointment, arrive 10 minutes late or more for your scheduled appointment, or call less than one hour prior to your appointment to cancel.
A notification letter may be mailed to you after “no show” visit. Repeated “no shows” may result in the family’s dismissal from our practice.
Well-Child Exams & Screenings
Routine well-child exams allow us to monitor for growth, developmental, behavioral and academic issues so that we can identify them early, intervene, and treat them effectively. Per the American Academy of Pediatrics, children should receive preventative care on this schedule. We expect parents to follow these guidelines so that we can provide quality healthcare to our patients.
We perform recommended screenings based on the patient’s age to detect any conditions that may need treatment. Most insurance plans cover these screenings and costs; however, their policies vary. It is your responsibility to understand which screening services are covered by your specific insurance plan.
Chronic Condition Follow-Ups
Chronic medical conditions such as ADHD, asthma, depression and anxiety require frequent follow-up to ensure the best care possible for your child. Patients with these conditions typically require regular follow-up visits several times per year. Medications may not be refilled unless patients keep their recommended follow-up appointments.
Medication Refills
Please contact our office 1 week prior to needing a refill of a prescription medication. You may do this through the Patient Portal (preferred) or by calling our office and choosing the option to leave a message on our refill line. Patients must be up to date on their well check exams/med check visits in order for prescriptions to be refilled. Please allow 2 business days for these to be processed.
After-Hours Care
If your child’s illness or injury is life threatening, dial 911.
Urgent Questions or Concerns
For urgent matters that cannot wait until business hours, call our office to be connected with a pediatric trained nurse. If needed, there is a physician on-call every night of the week.
Urgent/Emergency Care
If it is determined that your child needs to be seen by a medical provider outside of business hours, you may be referred to a pediatric facility. We are affiliated with Children’s Hospital Colorado. Review their options for urgent and emergency care to find a location near you.
Another resource is the pediatric emergency room at Rocky Mountain Hospital for Children.
Poison Control Hotline
(800) 222-1222
Suicide & Crisis Lifeline
Dial 988
www.988lifeline.org
Health Education Tools
- AAP Patient Education LibraryBrowse this library of expert advice from the American Academy of Pediatrics. This collection of over 800 handouts covers 200 topics ranging from Acne to Whooping Cough.
- Medication Dosage CalculatorBe confident that you are treating your child with the correct dose of Tylenol, Motrin, or Benadryl. We can guide you on how much to give, based on your child’s weight.
- Symptom CheckerUse this symptom checker to learn how serious your child’s symptoms are, whether you need to see the doctor, and how you can provide relief. Brought to you by the AAP and HealthyChildren.org.
Vaccination Policy
- We firmly believe in the effectiveness of vaccines to prevent serious illness and to save lives.
- We firmly believe in the safety of our vaccines.
- We firmly believe that all children and young adults, with rare exception, should receive all of the recommended vaccines according to the schedule published by the Centers for Disease Control and the American Academy of Pediatrics.
- We firmly believe that vaccinating children and young adults may be one of the single most important health-promoting interventions we perform as health care providers and that you can perform as parents/caregivers. The recommended vaccines and their most effective scheduling are the results of years and years of scientific study and data-gathering on millions of children by thousands of our brightest scientists and physicians.
- We firmly believe that the decision not to vaccinate not only affects the unvaccinated children, but also puts the entire community at risk.
- We firmly believe, based on all available literature, evidence, and current studies that vaccines do not cause autism or other developmental disabilities.
- We firmly believe that thimerosal, a preservative that has been in vaccines for decades and now remains only in some of the flu vaccines, does not cause autism or other developmental disabilities. Autism diagnosis rates continue to increase despite having the thimerosal removed in 2001 from all vaccines except influenza vaccines.
Resources
- Immunization ScheduleAmerican Academy of Pediatrics (AAP)
- Vaccine Information StatementsCenters for Disease Control and Prevention (CDC)
- Vaccine Safety: The FactsAmerican Academy of Pediatrics
- VaccinateYourFamily.orgHelping to protect people of all ages from vaccine-preventable diseases
- Institute for Vaccine SafetyJohns Hopkins Bloomberg School of Public Health
- Centers for Disease Control (CDC)
- Immunize.orgFormerly Immunization Action Coalition (IAC)
- Vaccine Education CenterChildren's Hospital of Philadelphia
These things being said, we recognize that there has always been and will likely always be controversy surrounding vaccination. As pediatric providers, we are committed to stay as up-to-date as possible on vaccine medical advances and studies and to share our medical recommendations and findings with our patients.
The vaccine campaign is truly a victim of its own success. We are extraordinarily lucky to live in an era in which vaccines have made many diseases so rare. It is precisely because vaccines are so effective at preventing illness that we are even discussing whether or not they should be given.
Because of vaccines, many of you have never seen a child with polio, tetanus, whooping cough, bacterial meningitis, diphtheria, or even chickenpox, or know a friend or family member whose child died of one of these diseases. Such successes can make us complacent about the true danger of vaccine-preventable diseases. But a complacent, “my child is not at risk for these diseases” attitude, if it becomes widespread, can only lead to tragic results. As medical providers, most of us have witnessed children seriously ill from or die from one of these diseases over the course of our careers, and it is something we wish desperately to prevent.
Numerous examples over the years have proven that when vaccine rates in an area dip, even by a little, outbreaks of previously rare diseases occur within a few years. For example, over the past several decades, many people have chosen not to vaccinate their child with the MMR vaccine after publication of a single study (which was later retracted as untrue) that the vaccine might cause autism. As a result of underimmunization, there have been outbreaks of measles and several deaths from complications of measles in Europe and the United States. In Nigeria, after pressure from leaders not to vaccinate children for polio beginning in 2001, polio rates have jumped from 30 cases per year to almost 900 cases per year.
We are making you aware of these facts not to scare or coerce you, but to emphasize the importance of vaccinating your child. We recognize that the choice may be a very emotional one for some parents. We will discuss the risks and benefits of vaccinations in a factual, non-judgmental fashion and let you know why we recommend the current schedule. However, should you have doubts, please discuss these with your health care provider. In some cases, we may alter the schedule to accommodate parental concerns or reservations. For some it is currently “trendy” to break up the vaccines, but any advantage of this has not been scientifically shown. Please be advised that delaying or “breaking up” the vaccines to give one or two at a time over two or more visits goes against expert recommendations, can put your child at risk for serious illness or death, and goes against our medical advice as medical providers. If immunizations are significantly delayed or inadequate, you will be asked to sign a “Refusal to Vaccinate” form acknowledging your understanding of the above risks to your child and family.
As medical professionals, we feel strongly that vaccinating children on schedule with all currently available routine vaccines is, with rare exception, absolutely the right thing to do for children and young adults. We have no “ulterior motive” for vaccinations, other than sincerely wishing the best health for your child. Thank you for your time in reading this policy, and please feel free to discuss any questions or concerns you may have about vaccines with any of us.
Resources
- Immunization ScheduleAmerican Academy of Pediatrics (AAP)
- Vaccine Information StatementsCenters for Disease Control and Prevention (CDC)
- Vaccine Safety: The FactsAmerican Academy of Pediatrics
- VaccinateYourFamily.orgHelping to protect people of all ages from vaccine-preventable diseases
- Institute for Vaccine SafetyJohns Hopkins Bloomberg School of Public Health
- Centers for Disease Control (CDC)
- Immunize.orgFormerly Immunization Action Coalition (IAC)
- Vaccine Education CenterChildren's Hospital of Philadelphia
Arvada Office
Office Hours
Monday - Friday
8:00 am - 5:00 pm
Saturday
8:00 am - 12:00 pm
Urgent care by appointment only
Sunday
Closed
Broomfield Office
Office Hours
Monday - Friday
8:00 am - 5:00 pm
Saturday
Closed. Patients can be seen at our Arvada location for urgent care, by appointment only.
Sunday
Closed
Holidays
We close our offices on the following holidays: New Year’s Day, Memorial Day, Independence Day, Labor Day, Thanksgiving Day, and Christmas Day.
After-Hours Care
If your child’s illness or injury is life threatening, dial 911.
For urgent matters that cannot wait until business hours, call our office to be connected with a pediatric trained triage nurse.
Poison Control Hotline
(800) 222-1222
Suicide & Crisis Lifeline
Dial 988
www.988lifeline.org
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