You have notified our office staff that you are currently without health care coverage or are choosing not to have coverage. We would like to take this opportunity to let you know the options that are available to you and your family.
Vaccines for Children
We participate in the Vaccines for Children (VFC) program. We can provide vaccines to your child for a minimal cost for the administration of the vaccine.
We offer a 20% courtesy discount if you pay on the day of service. This does not include vaccines.
Payment Agreement Terms
Balances over $300 will require a payment agreement.
Your child’s visit may include services that incur additional fees. These services can include and are not limited to: developmental assessments, questionnaires, medication, supplies, etc These charges may not be known prior to the exam.
Complete List of Clinic Forms
- New Patient Forms Packet
- Financial Policies
- Office Policies
- Pending Insurance Application Agreement
- Self-Pay Agreement
- Established Patient Forms
- ASQ Forms
- Third Party Forms
Please call the clinic at 503-554-0036 with any questions regarding these forms.