Forms & Policies

Office Policies, Downloadable & Secure Forms

Chronic Complaints Addressed at the Well Visit

If you are in the office for your child’s yearly well visit, as we always do, we will be reviewing any concerns you may have in regards to their health.  If there is a major “sick” or “chronic” health issue to address, your health insurer may require a co-pay or co-insurance payment for your visit as well.  If you have any questions about this policy, please ask your Provider or contact our office manager.

Form mailing

As of 10/01/18, all completed paperwork and forms will be available thru pick-up or portal only.  Families are encouraged to set up the PATIENT PORTAL (click the link or call the office) where you can access forms electronically and print them from home.     If mailing is the only option, parents are required to provide a stamped envelope.

In Office Mental Health Counselling (Updated 08/16/18)

Williamsville Pediatrics is pleased to offer mental health counselling in our office with Loretta Felder, LMHC.    She offers care for patients struggling with anxiety, depression, behavioral or relational problems.    She accepts most major insurers and there is a cash fee schedule available.    To speak to Loretta, please call 631-3510.   

Vaccines already drawn up (Updated 07/16/18)

If you are in the office to receive a vaccine, once you agree with your provider to accept it and it has been drawn up by the nurse, you are financially responsible for the cost if you subsequently decline that vaccine.   

Financial Policy (Updated 12/29/17)

The Financial Policy can be found here.

No-show Fees (Updated 12/29/17)

If you cannot make a well child visit, you must cancel 24 hours or greater in advance. If you do not show or cancel, a $50 fee will be charged to your account.

Food and Drink (Updated 09/28/16)

In the interest of safety for our food allergic patients, we have instituted a policy of no food or drink being brought into the clinical area of our office.    Thank you for respecting this new policy.

Late Arrival (Updated 6/15/15)

If you are going to be more than 5 minutes late for your appointment, we request that you call our office. If you arrive more than 15 minutes after your appointment time, the appointment may be cancelled and rescheduled. We work diligently to stay on schedule and ask that you arrive 15 minutes prior to your appointment time to allow time for any necessary paperwork..

Clinical Visit Summaries (Updated 5/17/13)

A short summary of your office visit is available within 24 hours after your visit and may be requested at any time. Please check with our receptionist if you would like one.

Insurance change (Updated 5/8/13)

Child Health Plus through BlueCross in Genesee and Niagara counties will be transitioning to Fidelis. If you are affected by this, be sure to choose one of our doctors as your PCP (primary care provider) if required at sign-up.

Form Fees (Update 4/04/14)

Due to the staff time involved, Williamsville Pediatrics charges $10 for physical form completion. If you bring forms with you to your well visit/physical appointment, it will be completed free of charge.

Williamsville Pediatric Center Vaccination Policy (Update 3/10/2014)

Download this and other Forms here.

After Hours charges (Updated 3/4/13)

For the convenience of our patients, and at the urging of local health insurance companies, Williamsville Pediatrics has evening hours. Each urgent office visit after 5pm during the week and also on Saturday mornings carries an "after hours" co-pay charge from your insurance company. If you have a "high deductible" type insurance plan, you may be responsible for this charge. Please check with your health insurance plan for the details of your coverage.

Age of patients (Updated 4/21/11)

Williamsville Pediatrics sees patients from birth up until their 20th birthday.

Lab Orders

Different insurance companies use different lab companies exclusively, and sometimes will not pay if you are sent to the wrong lab.

Please note that you are responsible for familiarizing yourself with your insurance carrier requirements.

Quest Diagnostics is the most commonly used lab in our area, and we will most likely be sending you there.

Williamsville Pediatric Center is not responsible for charges incurred if your insurance company does not participate with that lab.

After hours phone calls

The Lifetime Health Nurses Line will be closing. Our physicians will be taking ALL CALLS after hours.

Please limit calls to EMERGENCY QUESTIONS ONLY. All routine and non-urgent calls should be directed to the office during office hours.

Information regarding many typical topics of concern are available on this web site under "Parent Resources".

If you do have an urgent need to speak to a doctor after hours, our answering service number is 827-3536. Please allow up to one hour to receive a call back from the covering physician.

Developmental Screening

Our office follows the AAP recommendation to do routine screening for autism at 18 and 24 months.

Please be aware that your insurance may no longer be covering this service. While you may have a "zero co-pay" for well visits, this may not apply to all parts of the visit.

Alternative shot schedules

All patients using alternative shot schedules will need to see a provider (doctor or NP) for each visit involving shots, which depending on your insurance, may incur a co-pay that you will be responsible for at the time of the visit.

This is for your child's safety and to make sure they get the correct vaccine.

Co-pay collections

Starting March 1, 2009, we will be collecting the co-payment prior to your visit. If you are unable to pay the co-pay at that time, there will be a $10 service charge.