Ridgefield Pediatric Associates Forms & Policies

Walk-in hours

We accept walk-in patients for acute sick visits Monday-Friday, 8 a.m. to 9 a.m.

Appointments and sick visits

Please do not come to the office without calling first. We schedule appointments Monday through Thursday from 8 a.m. to 6:30 p.m., Friday from 8:00 a.m. to 5 p.m., and Saturday and Sunday by appointment only.

Appointments for sick visits are scheduled during regular office hours. Please try to call as early in the day as possible. We will always see your sick child the same day that you call, if necessary. Although we will make every attempt to schedule your child’s visit with your child’s primary care physician (PCP), schedules do not always permit this.

If you feel your child’s complaints are long-standing, complex health issues that need the services of your PCP, please tell our scheduling staff so we can schedule the right amount of time.

Follow-up appointments

We make every effort to open our schedule six months in advance. When you call for these appointments, we encourage you to see the same provider for continuity of care. Please try to make these appointments in advance so you can get the provider of your choice. Spring and summer are busy months, so we ask that you plan ahead.

Late policy

If a patient shows up 15 minutes late for a well visit and we cannot accommodate them in the schedule they will need to reschedule.

Evening, holiday, and weekend visits

We charge an additional after-hours fee for appointments after 5:00pm, weekend and holiday visits. Most insurance plans pay for this service; however, some plans charge the expense to the patient’s deductible. Please check the policy with your insurance plan.

Emergency care

Our providers are available 24 hours a day, 7 days a week on an on-call basis. If your child needs care after hours, call our office number and our call center will contact the provider on call to request a call back. You should hear from a provider within 20 minutes. If you don’t, please call back. If your child is having an emergency and you don’t think it can wait, please call 911 or take your child to the nearest emergency room right away.

Insurance information

Insurance companies require us to verify your insurance information before your visit, so please bring your child’s insurance card with you along with your copay.

Please understand that Ridgefield Pediatrics recommends when children should be seen for sick visits, well visits and rechecks. There are times when your insurance company may not pay for these visits. Our responsibility is to provide the best medical care for your child and we don’t base our frequency of care on insurance terms.

Ridgefield Pediatrics follows the recommendations of the American Academy of Pediatrics for age-appropriate screenings for development, autism, teenage concerns, eye exams and other visits. We do not know if your insurance carrier will cover these tests, so please check with your plan if you are concerned about costs. We want to do what is best for your child and believe these screenings are an important part in the care of your child.

Financial policies

Please take a moment to review our financial policies and current fee schedule:

• Ridgefield Pediatrics Financial Policy
• Ridgefield Pediatrics Fee Schedule

Vaccine charts

• Reasons to Vaccinate: Vaccine-Preventable Diseases and the Vaccines that Prevent Them
• Regular and Alternate Immunization Schedules and Standing Orders for Ridgefield Pediatrics

General patient forms

Forms may be printed and completed prior to your appointment with us.

• Health History Form
• HIPAA Acknowledgement and Consent Form (please read our HIPAA Privacy Policies before signing)
• HIPAA Consent Form (18 years or older)
• Authorization for Release of Patient Information/Records
• Minor Consent

Registration form

• Registration Form 2017

Travel forms

• International Travel Questionnaire
• Medical and Allergy Information

School forms

• School forms and Pre-school forms are done free of charge if they are required as a mandatory form for school entrance or grade acceptance. We suggest parents keep the school form on file for the years it is mandated and try to use this form when applying to camp. School forms can be obtained from your child’s school office.

Camp forms

• We have a $5.00 charge for camp forms. Camps usually have their own forms, and each camp’s form is different. It takes time for our staff to input the information that is necessary into this form and then each form must be reviewed by a provider and signed off on, assuring that all medical information is updated and accurate. We need approximately two weeks to complete the camp forms. If you need the form within 48 hours, there will be a $20.00 rush fee. We have thousands of camp forms to complete each summer and having you get them to us early in the summer is appreciated.

Screening form

• Impact Testing Questionnaire