Whole Child Pediatrics

Patient Name * Patient Date of Birth *

Some new rules have been implemented during the pandemic to ensure the safety of our patients and employees. Please read through and check to confirm your acknowledgment of our new procedures.

1. Mask Wearing

Because we are not able to abide by 6 foot distancing recommendation, we do require masks to be worn within our office. All adults must wear a mask or facial covering. Children over the age of 2 should wear masks if tolerated. Children under the age of two are not required to wear masks. If there are any adults who cannot wear a mask, please call our office at least 24 hours prior to your scheduled appointment to discuss why they cannot be worn. We can try to accommodate you.

2. Paperwork Requirements

All wellness, physical appointments, as well as new patient appointments require developmental paperwork. This paperwork is available on our website, www.idealpediatrics.com under the Forms tab. These forms are conveniently designed to be completed from a phone or computer. ALL AGE SPECIFIC FORMS MUST BE COMPLETED PRIOR TO YOUR SCHEDULED APPOINTMENT. Failure to have forms completed by the appointment time will result in the appointment being cancelled and a No Show fee applied.

3. Arrival Time

Previously, an allowance of 15 minute late arrival was permitted. At this time, due to the way we are scheduling during Covid to avoid office overlap, all patients must arrive by their scheduled appointment time. Arriving late will result in a cancelled appointment and a No Show fee per the amount labeled in the No Show Policy. Arriving on time, without paperwork completed also constitutes a late arrival and a No Show fee will be applied.

4. Arrive Procedure

To ensure we are adequatly prepared to meet you at the door for temperature checks and screenings, you MUST text us at 314-272-4005 and WAIT for a response to confirm you may enter our office. Do not enter our office without texting first.

5. Limiting People at Appointments

For the safety of our employees and our patients, we are trying to limit how many people are in the office at any given time. To do so, we are requesting you limit to ONE PARENT and ONE CHILD at your appointment. If you are scheduled to have 2 children seen, both children can come, but please only have one parent present. If you must bring an additional child to the appointment, please call our office with at least 24 hours notice so we can be prepared or make accommodations.

Name of person completing Policy Addendum * Relationship to Patient * Today's Date