Office Policies

​​HEALTH INFORMATION REQUESTS

  • HEALTH FORMS/ SPORTS FORMS/ IMMUNIZATION RECORDS:  We will be happy to fill out any health forms for your child, such as athletic and school physical forms. Please submit your request in writing (using the Health Information Request Form available in the office or on our website) or notify us via phone, and allow 5-7 business days for your form to be completed. We will call to let you know when it is ready to be picked up.  If you would rather have us mail your health form, please provide address information on the Health Information Request Form.  When possible, we will do our best to complete the health form during your visit with the doctor.  When picking up any medical records, health forms, doctor's letters, or prescriptions, you must present photo identification.  A charge of $10 will be assessed for each repeat form requested.

  • MEDICAL RECORDS:  Should you wish to acquire a copy of your child's medical records, you must submit your request in writing, using the Medical Records Release Form.  There is a $35 fee for records under 30 pages and a $50 for records 30 and over pages.  Payment must be made before the records will be released.  

PRESCRIPTIONS REFILLS

It is our policy that no new medications, including antibiotics, are prescribed without first being examined by one of our physicians.   For chronic conditions, we will be more than happy to refill your prescription, provided that we have been following your child for this condition.  ADHD medication refills require visits with the physician every one to three months.  Please contact our Prescription Refill Line (Option 4) for refill requests.  

REFERRAL REQUESTS

If you have an insurance plan requiring referrals from your PCP to obtain outside care or treatment, please contact our Referral Line (Option 5) with the following information:

  1. Patient name & date of birth
  2. Parent name & phone number
  3. Type of insurance & policy number
  4. Reason for referral
  5. Referred to physician (spelling of the physician’s first and last name) & NPI # if available
  6. Referred to physician phone number, fax number, & address
  7. Date of appointment

Please allow for 7 days to process your request.

APPOINTMENTS

  • NO SHOW POLICY:  If you are unable to keep your appointment, please contact the office prior to your scheduled appointment time.  A $25 fee will be assessed if the appointment is not kept without notification.  
  • LATE POLICY:  Please arrive promptly for your scheduled appointment.  If you are new to the practice or need to update your personal/insurance information, please arrive 10 minutes prior to your scheduled appointment time so that we may input your new information and help keep your appointment on time.  If you are more than 15 minutes late for your scheduled appointment time, we may need to reschedule your appointment for another time.         
  • WELL CHILD VISITS:  Well visits are scheduled 4-6 days after birth, 1, 2, 4, 6, 9, 12, 15, 18 months, 2 years, 2 ½ years, and once every 365 days thereafter.  A waiver must be signed for well visits scheduled prior to 365 after the previous well visit.  You will be responsible for any charges not covered by your insurance.  
  • VACCINATIONS:  A legal guardian MUST be present to authorize the immunizations.  Once you have authorized immunizations, our staff prepares the vaccination for use.  If you DECLINE the vaccination once it has been prepared, you will be liable for the cost of the vaccine on the day of your visit.  We cannot bill your insurance company for ​wasted vaccines. 

PAYMENT AND INSURANCE

  • COPAYMENTS/DEDUCTIBLES:  Many insurance plans require you to pay a copayment and/or meet a yearly deductible.  Copayments and yearly deductibles constitute a contractual obligation between you and your health plan provider. If the copayment obligation is not met, your health plan provider has the right to deny any and all charges, which could leave you responsible for all services rendered during your visit. 
  • PAYMENT POLICY:  Copayments are due at the time of service.  We accept cash, checks, Visa, MasterCard, Discover and American Express.  Statement balances may also be paid through this website.  Click HERE for online payments.  
  • INSURANCE PLANS: Each insurance plan is unique in its coverage, limits, and exclusions. We urge you to check with your health plan provider to find out what services are covered.  If a claim is rejected, please call your insurance company first.  PLEASE REMEMBER THAT IT IS YOUR RESPONSIBILITY TO KNOW YOUR INDIVIDUAL COVERAGE.
  • NEWBORNS: Remember to add your newborn to your insurance as soon as possible within the first month. This does not occur automatically.  Please notify us once this is complete and we will bill your insurance for accumulated charges from the first few months.  You will receive a statement from us that may include charges that you are not responsible for until we receive verification that your newborn has been added to your insurance.  If your insurance is an HMO or requires you to select a doctor, please remember to choose one of our doctors as your PCP (Primary Care Physician) to ensure timely payment of claims.  

CONTACT US

  • CALLS DURING OFFICE HOURS: We encourage you to call the office with your questions. Our billing department is available from 9:00 am to 5:00 pm, Monday through Friday.  For medical related questions, call us from 8:30 am to 4:30 pm, Monday through Friday.  You can talk to one of our medical staff or you may leave a message for your primary care doctor.  When you leave a message during office hours, we will do our best to get back with you as quickly as possible.
  • MAIN OFFICE NUMBER: 248-347-8040
    Option 1:  Appointment Scheduling
    Option 2:  Location, Hours, Website 

    Option 3:  Nurse Line/Lab Results
    Option 4:  Medication Refill Requests
    Option 5:  Referral Requests
    Option 6:  Billing Office     
    Option 7:  Office Manager
  • AFTER OFFICE HOURS CALLS: If your child becomes ill after office hours, and you cannot wait until the next day, please call our answering service at (248) 691-8683 and the doctor on call will contact you as soon as possible. While you are waiting for the doctor to return your call, please deactivate any call-blocking features on your phone. For privacy purposes, our doctors block their numbers. 

Forms

To expedite the registration process, please complete the registration packet and bring them in on your first visit to ​Twelve Oaks Pediatrics.  You will also need to bring your insurance card and driver's license of the guardian of the patient.

44070 W. 12 Mile Rd., Suite 100
Novi, MI 48377
(​248) 347-8040
AFTER HOURS EMERGENCY
(248) 691-8683