Pediatric Wizards Office Policies and Forms
Appointment Policy
As a courtesy, we allow 15 minutes for lateness. After 15 minutes, we reserve the right to reschedule (this includes both sick and well appointments).
We have a “reminder” policy, whereby all scheduled patients are called the workday before their appointment to confirm that they will be coming. We do not routinely “double” or “triple” book appointments. Therefore, if you do not call to cancel a scheduled appointment, you create a vacancy in our schedule which cannot be filled. For this reason, it is our policy to charge a $25 no-show fee for each missed appointment. Furthermore, our office may ask you to seek medical care elsewhere after three “no show” appointments.
Parent or Legal Guardian must accompany all patients to all appointments. (In the event that a secondary caretaker brings the patient in for an office visit, there must be written consent from parent or legal guardian before the patient is examined. Verbal consent will not be accepted.) Vaccinations may not be given unless parent or legal guardian is present to give authorization.
If you have scheduled a well appointment for your child and they are sick at the time of the appointment, they will be seen as a sick visit and the well visit will be rescheduled.
Waiting Room Policy
Please be aware of the separation between the sick patient area and the well patient area. Keeping these areas separate as well as having separate toys in each area is an infectious control measure. We ask for the cooperation of the parents in keeping their child(ren) confined to the appropriate waiting area for their own protection.
We ask that other children who are brought with the patient who has the appointment are not left unsupervised in the waiting room area. A suitable supervisor is an adult or family member 15 years of age or older. If you must bring other children with you without such a supervisor, they will be asked to accompany you and the patient into the examination room.
Picture/Birth Announcement Policies
Pictures and birth announcements given to Pediatric Wizards become the property of Pediatric Wizards and could be proudly displayed in the office.
We kindly ask that if you do not wish to have these displayed please indicate this on the announcement or photo.
In order to be fair, these policies will be enforced and do apply to everyone. The staff does not have the option to alter any of these policies.
Office Forms
The following forms are provided for your convenience.
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First Visit Forms 
These forms are needed for your first visit to Pediatric Wizards. Please fill them out prior to your first visit. Also, make sure to print out the patient information form found under the Patient Information Tab. If you are transferring from another practice, please click on and print out the medical records release form. Kindly fill it out and send it to their office so we may have your child's records prior to their first visit to our
M-Chat
Please fill these forms out prior to your child's 18 month & 2 year well visit in our office.
Prenatal Questionnaire
If you are seeing Pediatric Wizards for the first time prior to your due date, please download and fill out this questionnaire.
Newborn Feeding Questionnaire - 1 week visit
A questionnaire used to determine if you are experiencing feeding issues with a newborn or infant. Please fill this 24 hours prior to your 1 week follow-up visit in our office.
Medical Records Release Request
If you need a copy of your medical records for any reason, please fill these out and fax or bring them to our office.
ADHD Parent Evaluation and Follow Up Forms
These forms include parent evaulation and follow up forms for ADHD assesments and medication monitoring.
ADHD Teacher Evaluation and Follow Up Forms
These forms include teacher evaulation and follow up forms for ADHD assesments.
Medication Dosing Chart
Download or view the medication dosing chart for Tylenol, Motrin, and Advil.
Patient Information Form
Please fill out this form, print it, and then bring it with you to your next appointment.