Forms & Policies
Before your appointment with us, quickly and conveniently access patient forms from our practice.
Download Patient Forms
For each New Patient you will need to complete and submit a Registration Form, a Billing/Financial form, an Office Policies Form, and a Medical History Form (based on age).
All forms are available to download. To view the forms listed below, you will need Adobe Reader. You may download Adobe Reader for free at www.adobe.com.
ASQ Developmental Questionnaires are no longer available on our website. If you have a child age 2 months to 5 years, please arrive 10-15 minutes early for your child’s well child check appointment to complete the questionnaire.
Make a Payment Online
Your request will be processed within 24 hours, during normal business hours, Monday – Friday, 8:00 am – 5:00 pm, excluding holidays. If you do not receive confirmation of your request within 48 hours, please contact our office at 303-779-5437.
If you are more than 15 minutes late for a well-child visit, you will have to reschedule for another day/time.
If you are more than 15 minutes late for a sick visit, we will do our best to work you back into the schedule; however, there may be a wait.
Pediatrics 5280 does not accept walk-in patients. Visits are by appointment only. The only exception is a nurse visit for flu shots during specified times of the year.
Please do not ask to have your other children seen during a sibling’s appointment. If you have additional concerns about another child, please schedule that child their own appointment.
Visits may be scheduled with a nurse for immunizations, strep throat tests, and occasionally for lab draws if approved/ordered by one of our providers. All other patient evaluation requires a visit with a provider.
After Hours Phone Calls
Please limit calls after hours to emergency questions only. All routine and non-urgent calls should be directed to the office during regular office hours. There is information regarding a wide variety of illnesses and concerns, as well as many otc medication dosages on this website under Parent Information and Is Your Child Sick.
We are happy to fill out forms that you may need for your child that require a provider signature. However, HIPAA laws prevent us from being able to fax them to your child’s daycare, camp or school.
After Hours/Sunday Charges
Sunday and holiday clinic visits are for sick care only. Please be aware that there will an additional $50 charge for being seen outside of normal business hours. Your insurance company may pass this cost on to you, based on the policy you have with them.
ADHD/ADD Follow up and Refills
- Most ADHD/ADD medications (Concerta, Vyvanse, Adderall, Focalin, and Ritalin) are controlled medications. Standing refills are not legal on controlled medications. They cannot be phoned in to the pharmacy or sent electronically; they require a paper prescription.
- We are willing to write a 3 month mail-in prescription if you confirm your insurance will cover it.
- Only your child’s primary care physician will authorize refills or new prescriptions for a controlled medication.
- Please request your prescription at least one week before it is needed. We will mail prescriptions to your home if desired, or call you when it is ready for pick up at the office. There is no such thing as an emergency refill on ADHD/ADD medications. Your child will likely go without medication if you wait too long to request a refill.
- Any child who is on ADHD/ADD medications is required to follow up in the office with their primary care physician every at least every 3-6 months; more often if they are encountering difficulties.
- Changes in medication or doses may require an office visit.
In accordance with all applicable State and Federal Laws, Pediatrics 5280 does not discriminate against patients on the basis of race, color, national origin, sex, disability or sexual orientation. We do, however, only care for patients up to age 22, which is based on the nature of our pediatric medical practice.