Policies & Forms
Vaccine policy
Belleville Lake Pediatrics follows the childhood and adolescent immunization schedule recommended by the American Academy of Pediatrics. We require children in our practice to follow this schedule for the timing and type of vaccines received.
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. This may require additional "shot-only" visits between regularly scheduled appointments to stay on schedule. We do not offer elective vaccine delays or alternative vaccine schedules.
We are always happy to answer questions and discuss concerns about immunizations. Medical exemptions are considered in accordance with current medical guidelines.
Vitamin K and newborn screening
For the health and safety of our newborn patients, Belleville Lake Pediatrics requires that all newborns receive the recommended vitamin K injection after birth and complete the standard state newborn screening. These important preventive measures help protect babies from serious bleeding and identify certain medical conditions early, when treatment can be most effective.
Appointments and cancellations
We ask that families provide at least 24 hours' notice when canceling or rescheduling. A missed appointment or a cancellation made with less than 24 hours' notice results in a written warning the first time, a $25 fee the second time, and a $50 fee every time after that.
We understand that unexpected situations happen, so please contact the office as soon as possible. After three missed appointments or late cancellations, continued care with the practice may be reconsidered.
Late arrivals
If you arrive more than 15 minutes late, the visit may need to be rescheduled so that the families booked after you are not left waiting. You will be provided with written warning the first time this happens, but if you arrive late 2 or more times, each late visit without notice will be charged a $25 no show fee.
Prescription refills
Refills may be requested through the patient portal or by calling the 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. Belleville Lake Pediatrics does not charge a fee for records sent directly to another physician for your child's care.
Paper copies and requests from a third party such as an attorney, a disability program or a life insurer may be subject to a fee as permitted by Michigan law. You will be told about any applicable fee before the records are provided.
Privacy
This practice follows 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.
Before your first visit
Download the new patient packet, fill it in, and bring it with you. It saves about fifteen minutes in the waiting room and means the visit can be about your child.
Transferring from another practice?
Sign the medical records release as well and the office will request your child's chart for you.
Downloadable forms
Every form below can be completed on your computer or phone and saved, or printed and filled in by hand. Whichever is easier. Nothing here has to be done in the waiting room.
Sports physicals
Students participating in school sports in Michigan may need an MHSAA physical form completed before participation. We keep copies of the form available in our office, or you may print a copy from the MHSAA website and bring it with you to your child's appointment.
For a physical to be valid for the upcoming school year, it must be completed on or after April 15. If your child has already had a recent well visit, please contact our office to see whether another appointment is needed. There is no fee to complete the form when it is brought to your child's appointment.