New Patient Registration forms
Medical/Social History
Portal Enrollment Must be an established patient
Hippa
NEW PATIENT FORMS
The following forms may be completed prior to your visit with us.
Insurance Policies
Summit Pediatrics is enrolled in most managed care insurance programs. We are pleased to provide this service to our patients; however it is impossible for us to keep track of each plan's individual requirements. Please make sure you understand the benefits and requirements of your plan and be aware of any changes that may occur over time. Plans differ depending on the type of contract your employer may have negotiated. Some plans require wellness visits to be at least one full calendar year from the last wellness exam in order to be covered Your insurance is a contract between you and your insurance company; therefore, it is very important that you take an active role in understanding your benefits.
Newborns
It is important that you add your newborn to your insurance policy within the first 30 days of life. This will prevent any lapse in coverage. Contact your human resources department for the proper paperwork and their guidelines.

Primary Care Physician
If you have a plan that requires a primary care physician (usually an HMO or POS), you must specify your selection to the insurance company. Please select an individual Physician by name, as the insurance plans do not recognize group names.  The majority of companies will not back date a primary care physician selection, so it is important that this is specified before you are seen by one of our providers in order for the claim to process correctly. Some of the newer plans have an option where a primary care physician is not required; however, specialist copays may apply.


If you have specific questions regarding a bill you received from our office, please contact our business office. 716.298.4454.
Authorization for Release of Medical Information
 
PATIENT PORTAL
Summit Pediatrics-Where your child's good health is paramount.


We are available 24 hours a day, 7 days a week. We offer Urgent Care appointments on Saturdays
716.298.4454
M-Chat   15 month   2 yr
New Patient Welcome Packet