Office Policies & Forms
Patient Rights & Responsibilities
Thank you for trusting us with your child's healthcare. We strive to provide care that is exemplary in quality and compassionate in delivery. In treating your child, we follow guidelines established by the American Academy of Pediatrics and deliver evidence based recommendations.
We are dedicated to the protection of your family's personal data. Our Patient Privacy Policy describes the rights you have over your data.
Vaccination Policy
Vaccines are lifesaving and safe. To promote the health of our patients, other Prairie families and community members, we require all patients to be up to date on their vaccinations and to follow standard vaccination schedules. We do not offer "alternate" schedules for patients.
Our vaccine schedule shows both required & recommended vaccines and ages at which vaccines are administered.
Cancellation & Late Arrival Policy
To ensure we remain available for children who are in need of care, we have a strict 3-strikes policy. After 3 times arriving 15+ minutes late, missing an appointment or cancelling with less than 2 hours notices, families will be dismissed from the practice.
We also kindly request 24 hours notice for any cancellations.
Financial & Office Policies
We strive to be transparent about the policies & responsibilities that exist to enhance our ability to provide great, seamless care for our patients in our Financial & Office Policies. Some examples include:
Providing Insurance Information: Accurate and current information must be provided for all visits.
Knowing Your Benefits: Understanding your insurance plan copay, deductible and coinsurance responsibilities helps avoid surprises.
Card on File: Patients are required to keep a credit/debit card on file to cover services that are not paid for insurance.
After Hours Care: Evening (after 5pm), weekend and holiday visits (includes all federal holidays) have a $30 convenience charge.
PCP Designation: If your insurance requires a Primary Care Physician designation, you must name our practice as the PCP prior to your visit.
Form Return Process and Form Repository
Prior to your scheduled visit, you will receive any required forms via text through the Spruce app.
Forms can be printed, completed and then texted back using Spruce by scanning or taking a picture of all pages of your completed forms.
General Forms:
- Release of Medical Information TO Prairie
- Release of Medical Information FROM Prairie
- Co-Parenting Policy
- ADHD Policy
Developmental Questionnaires for Well Visits: