Please print and complete the New Patient Handouts and return to our office at your first visit.

*  As a courtesy, all patients are contacted in advance of their         Well Care appointments. Please be advised that a $25.00 No       Show fee will be charged to your account if cancelled less             than 24 hours of scheduled appointment.                                                                                                                     
*  All Insurance cards should be brought to the office at time of       visit.  This is to verify insurance changes.
*  Please notify the front desk of any address; phone;                   email or insurance changes.

 You are contracted with your insurance to pay a copayment at time of visit.  If the copay is not met at time of visit, there will be an additional $20.00 in addition to your copayment charged to your account.

 There is a charge for all school forms; camp forms; scout forms, etc.of $10.00 per form, per child.  If mailing your forms; please include full payment.  Please complete all your necessary information prior to giving us the form.  Sports Physical forms require Part A to be completed and attached to Part B before the doctor can complete their portion.  All forms requested to be returned within 24 hours will incur a $15.00 rush charge.

Here at Bergen West Pediatrics, we try and put in place policies and procedures so all of our patients are treated fairly and professionally.