Check List for Patients

Welcome to Dr.Mandi’s Integrative Pediatrics! We have put together a checklist for your appointment.

1. Paperwork/Forms and Information: please download and print the forms on our website, and bring in the completed paperwork 15minutes prior to your first appointment. If there are any changes to your account in the future, please provide us with the updated information. If you need to cancel the appointment, please notify us 24hours in advance.
2. Medications: It is important to bring in the medications you are taking, for us to review with you and to enter in your chart. This would include vitamins, over-the-counter medications, herbal remedies, supplements, etc.
3. Insurance Card and Picture ID: Please remember to bring in the insurance card with the patient name on it. We will take a copy of the card and of the legal guardian’s picture ID. Look at your insurance card, if it has a listing for a PCP or Primary Care Physician, please make sure that it has our clinic listed on it. Please notify us of any changes to your insurance plan, and provide us with an updated copy.
4. Co-payments: Please remember to bring your co-pay. Insurances require we collect the fee for each visit at the time of service. Please look at your insurance card to note the amount.
5. Parents of Newborn Children: Please be advised that Newborns must be registered on your insurance within 30days of birth, or it is likely that your insurance will not cover the visits. Please bring your child’s insurance card with you.

Please download, print, and fill out these forms prior to your first appointment.

Authorization to Release information
Developmental History
Health History Form
HIPAA Privacy Form
HIPAA Signature Form
Patient Insurance Form
Patient Registration Form
Practice Policy
School and Social History Forms
Signature Page Form