About Us

Your First Visit

 

WHAT TO BRING TO YOUR FIRST APPOINTMENT

At your first appointment, you will need:

  • your insurance card (bring this to every appointment)
  • a co-payment, if your insurance requires one
  • the patient's date of birth
  • your child's social security number (and the social security numbers of any other children you would like for us to enter into our system)
  • the social security number of the person whose health insurance you are using
  • the social security number of the parent who is bringing the child to the appointment

 

New Patient Forms

We have some forms you can fill out online, then print, sign and bring with you to your child's first appointment. Filling these out before your child's first appointment will save you time and make things run more smoothly.

New patient forms may be found here.
 
 
Transfer/Release Medical Records
 
If your child previously received care from another provider at another clinic or office, his/her records are not automatically transferred to our office. If you wish to have records transferred from another office, we have a release prepared that can be used. You should fill this out and ask to have the files transferred to our office before your child's appointment at Cottonwood Pediatrics.
 
This form can also be used to authorize Cottonwood Pediatrics to release your child's records to another health care provider.
 
You may download the release form by clicking here, fill it out and take or mail it to your child's previous health care provider. Some health care providers may charge for this service. If you are transferring records from Cottonwood to another provider, you may download and fill out the form and then bring it in to Cottonwood Pediatrics.
 
 
The "Step-parent" Consent
 
Many of our patients are members of blended families.  We recognize that non-biological parents may bring children to appointments at our office, and adding this permission to our records will make appointments and billing go more smoothly.
 
This consent can remain in effect until the child is 18 or may be given for a specific length of time.
 
Download this Consent to Treat by clicking here
 
Fill it out and mail or fax to our office at 316-283-7118 BEFORE your child's appointment to avoid any delays in treatment.
 
 
The "Grandma" Consent
 
Is grandma bringing your child to an appointment while you are at work?  You may give any caregiver permission to have your child seen at our office.
 
This consent can remain in effect until the child is 18 or may be given for a specific length of time.
 
Download this Consent to Treat by clicking here
 
Fill it out and mail or fax to our office at 316-283-7118 BEFORE your child's appointment to avoid any delays in treatment.
 
 
The "Teenager" Consent
 
If your child is at least 16, he/she may consent to his/her own treatment.  You can send your child to the clinic for routine treatments and exams without you. 
 
This consent can remain in effect until your child is 18 or may be given for a specific length of time.
 
Download this Consent to Treat by clicking here.
 
Fill it out and mail or fax to our office at 316-283-7118 BEFORE your child's appointment to avoid any delays in treatment.