Office Procedure and Financial Policy Thank you for choosing us as your pediatric office - glendalep 2026

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by reading the introduction carefully. This section outlines the importance of understanding both medical and financial relationships with Glendale Pediatrics.
  3. Proceed to the 'Insurance Verification' section. Here, ensure you understand your insurance coverage and provide proof of current insurance at your visit.
  4. In the 'Payment for Services' section, complete and sign the Credit Card Authorization form as required before leaving the office.
  5. Review the 'Cancellation Policy' to understand potential charges for missed appointments. Make sure to note any necessary actions if you need to cancel.
  6. Fill out any additional sections regarding health issues during preventative care appointments, unscheduled appointments, and Saturday consultations as applicable.
  7. Finally, sign and date at the bottom of the document to confirm that you have read and understood all policies outlined.

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