(303) 779-5437 Login to MyChart Meet Us Locations For Parents Pediatric Services Counseling Services New Patients Forms & Policies Forms & Policies IN THIS SECTION FORMS & POLICIES BILLING & INSURANCE MAKE A PAYMENT Request an Appointment Pay Your Bill Immunization Schedule Latest News PEDIATRICS 5280 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. Patient Registration Billing and Financial Form Office Policies Form Pediatric History Newborn to 11 months Pediatric History 1 year to 8 years Pediatric History 9 years to 22 years Transfer Medical Records To Pediatrics 5280 Transfer Medical Records From Pediatrics 5280 Release of Information – Age 18 and Older Iron Mountain Medical Records Request Form 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. Pay Your Bill Online PRACTICE POLICIES General and Financial Policies Notice of Privacy Policy Fifteen Most Commonly Provided Services LATE PATIENTS 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. WALK-IN PATIENTS 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. ADD-ON PATIENTS 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. NURSE VISITS 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. DAYCARE/CAMP/SCHOOL/SPORTS FORMS 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, Ritalin etc.) are controlled medications. Standing refills are not legal on controlled medications. 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. 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. NON-DISCRIMINATION POLICY 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. Pediatrics 5280 Non discrimination SUBSCRIBE TO NEWSLETTER CENTENNIAL OFFICE 9094 E. Mineral Ave. Suite 120 Centennial, CO 80112 Phone: (303) 779-5437 Fax: (303) 689-9628 CASTLE ROCK OFFICE 2352 Meadows Blvd #150 Castle Rock, CO 80109 Phone: (303) 779-5437 Fax: (720) 402-3555 Home Meet Us Locations Patient Information New Patients Forms & Policies News Copyright 2021 Pediatrics 5280 | Privacy Policy | Photo Disclaimer | Sitemap medical webdesign by practis, inc