Policies & Forms
Clear rules, written like a human wrote them. Download what you need before your visit.
Vaccine policy
Belleville Lake Pediatrics follows the childhood and adolescent immunization schedule recommended by the American Academy of Pediatrics, and we require our patients to follow the AAP-recommended schedule.
We happily welcome children who are behind on vaccines and will work with families to create an appropriate catch-up plan. Vaccines may be split between visits when medically appropriate, provided your child remains on schedule. However, we do not offer elective vaccine delays or alternative schedules.
We are always happy to answer questions and discuss concerns about immunizations. Medical exemptions are considered in accordance with current medical guidelines.
Appointments and cancellations
We ask that families provide at least 24 hours’ notice when canceling or rescheduling. A fee will be charged for missed appointments or cancellations made with less than 24 hours’ notice.
We understand that unexpected situations happen and encourage you to contact us as soon as possible. After three missed appointments or late cancellations, continued care with our practice may be reconsidered.
Late arrivals
If you arrive more than 15 minutes late, we may need to reschedule your visit so that we do not run behind for the families after you.
Prescription refills
Refills may be requested through the patient portal or by calling our office. Please allow up to three business days, and plan ahead, as medications are not refilled after hours.
Patients taking medications for ADHD or mood concerns must be seen at least every six months when stable. More frequent follow-up may be required when starting a medication, adjusting a dose, or based on your child’s individual needs.
Financial policy
Copays and patient-responsibility amounts are due at the time of service. Accepted payment methods will be confirmed before opening.
Payment plans are available for larger balances. If you are worried about a bill, please contact the office rather than avoiding care. We would much rather work something out with you than have a child go unseen.
Forms and paperwork
There is no fee for completing school, camp, sports, or work permit forms. Please allow three to five business days for forms dropped off separately.
Medical records requests
Submit a signed release and allow 10 business days for routine requests. Records going to another physician are sent at no charge.
Privacy
We follow HIPAA. Teen patients have confidentiality protections for certain visits under Michigan law, and we will explain what that means for your family at the right age.
Downloadable forms
PDFs, ready to print and fill out. Links go live once the forms are finalized.
- New patient registration
- Medical records release
- Consent to treat
- Notice of Privacy Practices
- Medication authorization for school
- Sports physical form
- Financial policy acknowledgment