| Consultation letters/reports |
$15.00 – 25.00 |
|
| Early Intervention Form |
$25.00 |
in addition to any other fees incurred |
| Forms needed within 48 hours |
$20.00 |
|
| No-show fee, Well Visit (Physical Appointment) |
$50.00 |
24-hour notice must be given for cancelled appointment |
| No-show fee, doctor appointment |
$25.00 |
24-hour notice must be given for cancelled appointment |
| No-show fee, nurse appointment |
$15.00 |
24-hour notice must be given for cancelled appointment |
| Copy of chart fee |
$25.00 per child |
|
| Bounced check fee |
$25.00 |
|
| Co-pay not paid at time of service |
$10.00 |
|
| Fee for bills not paid within 30 days |
$10.00 per month |
|
| Physical exam form (school/camp, etc.) |
$5.00 for each additional or duplicate forms |
A Universal Form will be filled out at time of annual physical exam and provided free of charge. Patients must make additional copies of this form for their own records. If you have joined the patient portal, a copy of your universal form will be available under forms for you to print out at any time free of charge. |
| Allergy & Asthma Forms |
$5.00 |
The charge applies for each allergy and asthma form that is filled out. |
| Sports Physical Form |
$10.00 |
The charge applies for sports physical forms that are required by the State of New Jersey. If the sports form is not filled out at the physical, there will be a $20 charge. If you have joined the patient portal, a copy of your sports form will be available for you under forms to print out at any time free of charge. |
