Forms & Office Policies
We’ve provided for easy download, office forms and handouts for your convenience. If you do not have a copy of Acrobat Reader you can get one for free by clicking here. This will take you to Adobe’s website and enable you to download the Acrobat program to your computer.
Click Here: New Patient Welcome Packet
Your Welcome Packet has documents and forms that need to be reviewed and signed before your first appointment. To speed up the check in process, it is helpful if you fill out these forms before your appointment and bring them along with you. Included in your packet is a Release of Medical Information Form. Once completed, please give this to the clinic that you are transferring from so that your child’s records can be forwarded on to Goldstar Pediatrics.
We strongly believe vaccination is important for all children to protect them against vaccine-preventable diseases.
We follow the schedule approved by the CDC and AAP and offer all vaccines at the recommended ages and intervals.
Co-pays are required by your insurance company and are due at the time of the visit. Co-pays not settled at the time of the visit will attract a fee of $10.00.
* Copay and Administrative Fees are not applicable to patients on Medicaid.
We require that a credit card, debit card or Health Savings Account card be kept on file with the clinic for purposes of collecting copayments and / or deductibles, cost sharing per your insurance benefits.
Arriving late to your appointment creates an inconvenience for the other patients scheduled to be seen after you. Patients arriving 15 minutes after their scheduled appointment time will be asked to re-schedule. Late arrivals for sick visits will be worked into the schedule, but will have to wait for the next open slot.
Cancellation and No Show Policy
We require one business day’s notice if unable to make it to an appointment. This allows us to open up the slot for another patient. We encourage you to give ample notice if you cannot make an appointment. Missed appointments without prior notice are considered no-show which will attract a no-show fee.
Insurance eligibility will be verified before each visit. Below is a list of insurance plans we are contracted with. We continually update the list of accepted insurance plans. Please contact the office for our most updated list.
- Aetna PPO
- Anthem Blue Cross PPO
- Blue Shield PPO (Including Covered CA Plans)
- Cigna PPO
- Health Net PPO
- United Healthcare PPO
Families who prefer to pay out of pocket are welcome.
Please contact the insurance company directly for specific plan participation