Forms & Policies

Before your child’s appointment with us, quickly and conveniently access patient forms from our practice. To download the forms listed below, you will need Adobe Reader.

Please bring your completed forms with you to our office at the time of your child’s visit.

Download Patient Forms

Influenza Vaccination Forms

Office Policies for Current Patients

Check In

Upon arrival, please sign in at the front desk and be prepared to present your picture ID and insurance card if needed. Please let us know if there have been any address or phone number changes.

Late Arrival

If you are going to be late for your scheduled appointment you will have a 15 minute window. If you feel you might be more than 15 minutes late, please call the office to confirm that your provider will still be able to see you.

Insurance & Payment

You will be responsible for any co-pay, co-insurance or deductible at the time of each visit. Any outside balances are due upon receipt of your statement. You can also pay balances online at If you have any questions about what your insurance plan covers please contact your insurance company.

Prescription Refill

Please allow 3 days for routine prescription refills. You may call the office during working hours for questions regarding prescriptions.

Form Requests

Our office requires that ALL patients are up to date on physical wellness exams before physical forms are completed. Typically those forms and a shot record are provided at the physical wellness appointment. We ask that you allow our staff 48-72 hours to complete requested forms. Thank you for your understanding.

Cancellation/ No Show Policy

We understand that occasionally you may need to cancel your appointment. Please notify the office of the cancellation at least 24 hours prior to the scheduled appointment. Failure to do so is considered a no-show and will be subject to an additional charge.

Contact Orange Park Pediatrics for more information or to schedule an appointment at one of our locations.