Policies & Forms
Learn about the policies that help us provide your children with the very best of care.
Patient Forms & Downloads
Questions about which forms you might need? Please call our office and our staff will assist you in preparing for your child’s visit.
New Patient Forms
- To expedite your first appointment, please download and print our new patient forms, fill them out ahead of time, and bring them with you to the appointment.
- New Patient RegistrationPaquete de registro de nuevos pacientesEn Español
- Medical HistoryCuestionario de Historial MédicoEn Español
- Medical Record Request
- Notice of Privacy Practices
- VFC Eligibility FormVFC Forma de ElegibilidadEn Español
Policy Documents
- Financial & Office PoliciesPolíticas financieras y de oficinaEn Español
School Forms
- Health Assessment Record (Birth to 5 Years)Registro de la Evaluacion de salud de la nines temprana (0-5)En Español
- Health Assessment Record (5 Years and Older)Registro de la Evaluacion de salud de la nines tempranaEn Español
- Asthma Action Plan (Birth to 11 Years)
- Asthma Action Plan (12 years and Older)
- Medication Administration Form
- Food & Allergy Anaphylaxis Emergency Plan
Billing & Insurance
Summer Pediatrics is dedicated to providing accessible, high-quality health care services to our patients. Understanding your financial responsibilities is an essential part of your child’s care. If you have any questions concerning these policies, please contact our office.
Your Responsibilities
- To know the limits and coverage of your particular health insurance policy.
- To show your insurance cards to us at each visit.
- To pay any copays at the time of service.
- To provide updated address, phone numbers, and insurance information to our office.
Our billing staff will do their best to assist you with insurance questions. However, if you have questions about your coverage, it is best to check with your specific insurance company.
Accepted Insurance
- Our office accepts most (but not all) plans with these insurance companies. It is your responsibility to check with your insurance carrier to confirm that your plan is in network with our office.
- Aetna
- Blue Cross Blue Shield
- Cigna
- Connecticare
- HUSKY Health/Medicaid
- Multiplan
- Oxford
- PHCS
- United Healthcare
Copayments
Copays and any past-due balances will be collected at the time of your visit. Please check with your insurance company to determine the dollar amount of your co-payment prior to your appointment.
Self-Pay
If you are not covered by a medical insurance plan, payment is expected at the time services are provided.
Office Policies
We require an appointment for your child to be seen. Please call during office hours to make an appointment or speak to a nurse who can answer any routine questions you might have about your child.
Please call us as early as possible to schedule a visit for your sick child. Our team will do our best to schedule a same-day appointment.
Mutual Respect of Time
Our providers strive to stay on schedule. Although there can be emergency situations that prevent us from running on time, we pledge to provide quality care with minimal wait time to the best of our ability.
To respect your time, we make the following requests:
- Please arrive at least ten minutes prior to your appointment time. Please have your photo ID, insurance card and needed forms available upon arrival.
- If you are running late, please call the office. If you are more than 15 minutes late, you may be rescheduled so that other patients are not inconvenienced, or you may be seen if the day’s schedule permits.
- We require a minimum of a 48 hours notice for cancellations. You will be charged $50 for a missed scheduled appointment. If you do not show to 3 appointments per family, you will be discharged from our practice.
Medication Refills
Prescription refills must be requested through our patient portal. Pharmacy requests will be denied. Please allow 48 to 72 hours for all prescription refills.
- If a medication is used daily and you do not have any refills left, please notify us at least 1 week before your prescription runs out. We will review your medical record to determine if a follow-up visit or medication adjustment is needed before refilling the prescription. You can also call our office to speak with a nurse if you are unsure if your child needs to be seen.
- To ensure the best care for your child, we require regular follow-up appointments for all mental health medication management. Follow-up visits are typically scheduled every three months, although some patients may need to be seen more frequently based on their individual treatment plan. Please notify our office at least one week before your medication supply runs out, as it may take 3–4 business days for the prescription to be ready. Prescriptions will be sent electronically to your pharmacy of choice, we do not mail or print prescriptions. If a refill is requested and there has not been a follow-up visit within the designated timeframe, you will be asked to schedule an appointment before a refill is provided. Thank you for helping us provide consistent, high-quality care to your family.
- Patients must have annual visits to receive Albuterol and Epi-Pen refills.
After-Hours Care
If your child’s illness or injury is life threatening, dial 911. This includes loss of consciousness, severe bleeding, seizure, etc. In the case of injuries such as cuts, mild fractures, and sprains, please call our office first for instructions.
Phone Triage
For urgent matters that cannot wait until business hours, call our office to be connected with a pediatric trained triage nurse. They will contact our on-call provider, if needed.
Poison Control Hotline
(800) 222-1222
Suicide & Crisis Lifeline
Dial 988
www.988lifeline.org
Hospitals/Emergency Care
We are affiliated with Stamford Hospital. Review their options for urgent and emergency care to find a location near you.
Stamford Hospital
One Hospital Plaza
Stamford, CT 06902
Map & Directions
203-276-1000
Urgent Care
| Location | Hours |
|---|---|
| Nuvance/Gohealth 1011 High Ridge Road, Suite 101 Stamford, CT 06905 475-477-2330 | Daily: 8am – 8pm |
| American Family Care (AFC) 3000 Summer St. Stamford, CT 203-969-2000 | Mon – Fri: 8am – 8pm Sat – Sun: 8am – 5pm |
| Hartford HealthCare 950 High Ridge Rd. Stamford CT 06905 203-324-5740 | Mon – Fri: 8am – 8pm Sat – Sun: 9am – 5pm |
| Tully Health Center 32 Strawberry Hill Court Stamford, CT 06902 203-276-4222 | Mon – Fri: 7am – 8pm |
Urgent Orthopedic Care
| Location | Hours |
|---|---|
| Yale Medicine Orthopedic 260 Long Ridge Rd Stamford 877-925-3637 | Mon – Fri: 8am – 8pm Sat : 8am – 12pm |
| ONS 6 Greenwich Office Park Greenwich, CT 06831 203-869-1145 | Mon – Fri: 4pm – 6pm Walk-ins only |
| ONS 249 Danbury Road Wilton CT 06897 203-869-1145 | Mon – Fri: 4pm – 6pm Walk-ins only |
| CT Children’s Specialty Care 191 Post Rd W Wesport, CT 06880 860-545-9100 | Mon – Fri: 7am – 8pm Call for same day appointments |
Vaccines Save Lives
At Summer Pediatrics, we strive to provide comprehensive, family-centered care for all of our patients. We aim to maintain a safe environment where our families receive exceptional medical care compliant with both the American Academy of Pediatrics (AAP) and the Centers for Disease Control (CDC).
We firmly believe that vaccinating our patients is one of the most important services we offer. Vaccines prevent serious illness and save lives. We recommend that children and young adults receive vaccines according to the schedule published by the AAP and CDC. The published schedule is the result of years of scientific study and accumulation of data on millions of children.
If your decision is to decline immunizations, we will ask you to find another healthcare provider who shares your views.
Resources
- Immunization ScheduleAmerican Academy of Pediatrics (AAP)
- Vaccine Information StatementsCenters for Disease Control and Prevention (CDC)
- Vaccine Safety: The FactsAmerican Academy of Pediatrics
- VaccinateYourFamily.orgHelping to protect people of all ages from vaccine-preventable diseases
- Institute for Vaccine SafetyJohns Hopkins Bloomberg School of Public Health
- Centers for Disease Control (CDC)
- Immunize.orgFormerly Immunization Action Coalition (IAC)
- Vaccine Education CenterChildren's Hospital of Philadelphia
Summer Pediatrics
Office Hours
Monday - Friday
8:00 am - 5:00 pm
Please call during office hours to make an appointment or speak to a nurse who can answer any routine questions you might have about your child.
After-Hours Care
If your child’s illness or injury is life threatening, dial 911.
For urgent matters that cannot wait until business hours, call our office to be connected with a pediatric trained triage nurse.
Poison Control Hotline
(800) 222-1222
Suicide & Crisis Lifeline
Dial 988
www.988lifeline.org
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