Capitol Pediatrics :: Our Love for kids keeps growing

Capitol Pediatrics :: Our Love for kids keeps growing

Forms & Policies

Forms you may need

For your convenience we have included a list of printable forms. You may be asked to bring one or more of these forms to your upcoming visit.


Medical Record Release Policy
If for any reason you require a copy of your child’s medical record, there will be a charge of $25.00 and a release form must be completed and signed.

Cancellation Policy
Appointments must be cancelled at least 24 hours prior to the appointment time. Failure to do so will result in a “No Show” (see below). If there are extenuating circumstances regarding your cancellation, please inform us so that we may handle it accordingly.

“No Show” Policy
We as an office prepare for your child’s visit. It is very important when you schedule an appointment to keep it. Our providers have limited time slots during the day to see patients. By not keeping a scheduled appointment, our physicians’ ability to provide service to other patients is restricted. As a result, if you cancel an appointment without giving 24 hours notice, or fail to come to your scheduled appointment, this will result in a “No Show.” In the event you are counted as a “No Show” to an appointment, a letter will be sent out to you stating the appointment you missed and reminding you of our policy. If you are a “No Show” to three or more appointments, your relationship with the practice may be terminated.