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.
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.
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:
Please allow for 7 days to process your request.
PAYMENT AND INSURANCE
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
AFTER HOURS EMERGENCY
Twelve Oaks Pediatrics
44070 W. 12 Mile Rd., Suite 100, Novi, MI 48377
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