Forms & Policies

Patient Forms

Before your next appointment, please take an opportunity to view forms that are required for all new patient visits. You can cut down on time in the waiting room by printing and completing these forms and bringing them to our office.


New and returning patients should arrive 15 minutes prior to your scheduled

We allow for a 15 minute grace period for your scheduled appointment time. Patients arriving after the 15 minute grace period may be asked to reschedule.

Walk-In Hours

In an effort to serve all patients more efficiently, effective immediately, Princeton Lakes Pediatrics will no longer accept Walk-Ins. All patients must have an appointment to be seen.

We sincerely value all of our patients and strive to give each individual our dedicated attention and care. If you child is sick and needs to be seen by a doctor, please call the office or speak with the reception to schedule an appointment. Please contact us during our regular office hours at (404) 629-1880.

Pharmacy Prescriptions

Please contact our office by phone, or complete the Prescription Request in our online portal.

Medical Records*

Patient medical records can be requested at any time. We ask that you complete a Authorization to Release Medical Information form to get your medical records. Please access the patient portal or contact our office for access to the form. *please note: additional fees may apply for requesting some forms


All co-payments are due at the time of each visit.

We accept all major credit cards:

  • Visa
  • MasterCard
  • Discover
  • American Express

We also accept cash payments and personal checks.

To see a full list of insurance providers we accept, visit our Insurance section.

Financial Policy

Please refer to the following documentation to review the Financial Policy that our practices addresses regarding office visits, forms of payment, managed care and other items.

Office Visits

All office charges are payable at the time services are rendered. For your convenience, we  will provide you with a copy of the encounter form documenting the charges and receipts for your visit which you may use to file for reimbursement with your insurance carrier. If you are scheduled for a Well Child Check-up and other health concerns are brought up that would typically require a separate visit, your insurance company may consider these two separate visits and bill your co-pay and other charges accordingly. Additionally, if it is determined that we need to treat a medical condition or must order additional tests or labs at the Well Child Check-up, your bill will reflect all services rendered. You may consider the appointment as one visit, but your insurance company may not. In that case, you could be billed for co-pay, co-insurance or the service could be applied towards your yearly deductible.

Financial Responsibility For Minors

Unless prior arrangements have been made, charges for a minor child seen in the office will be the responsibility of the adult accompanying the minor child.
Divorce, Separation, and Custody Agreements
Princeton Lakes Pediatrics will not be party to custodial, separation or financial disputes relating to individuals with regard to minor children to whom services are provided. The individual who requests the medical services and signs the financial agreement is responsible for any
balance due. All co-pays, co-insurance, and deductible, if applicable, will be collected at the time services are rendered from the individual requesting the medical services for the minor child/children. We will not call the other parent for consent. The physician will discuss the
minor’s medical information with the accompanied parent at the time of the visit. Princeton Lakes Pediatrics will provide a copy of any medical records requested, although we reserve the right to charge a fee. Both parents have access to the minor child’s medical records, unless there
is a court order that specifically mandates only one of the parents to have the right to authorize medical treatment and release of the minor’s medical records. We reserve the right to discharge any patient from Princeton Lakes Pediatrics if an issue comes between the (divorced/separated) parents which would disrupt our practice. We maintain that divorce, separation, and custody agreements should not enter into the medical care of a child; such matters should remain between the parents.

Office Tours

We offer new and returning patients the option to meet our doctor and staff during. Please RSVP with our staff to reserve your open house slot.

Cell Phone Usage

For the courtesy of those around you, we ask that cell phones not be used in the waiting room.

Princeton lake Pediatrics

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