Patient Resources

New Patients at Wellness Pediatrics

New Patients

We are currently accepting new patients into our practice. Please fill out the Patient Registration Form and HIPAA form, and bring both to your child’s first appointment along with:

• Your insurance card
• Valid photo ID
• Copy of immuization records
• Copay (if applicable)

Please plan to arrive 15 minutes before your scheduled appointment to ensure your registration information is complete.

NON-COVERED SERVICES POLICY

(EFFECTIVE JANUARY 1, 2020)

Many services we provide are non-covered services, meaning that they are not paid by any insurance company. These are allowable services in a medical practice, but insurance companies do not pay for them. Consequently, we have decided to charge a single annual fee so that all patients can have ready access to a complete range of services they need. This fee covers services such as:

• Completing medical clearance forms for childcare centers, schools, sports, camps, employers, and preparing letters of medical necessity, without a limit to the number of forms
• Completing refill requests without an office visit (does not apply to controlled substances)
• Extended evening hours which save you an urgent care/ER copay
• Sending medical records to specialists
• Providing copies of records upon request, should you relocate or leave the practice for any reason
• Maintaining a web-based secure patient portal to allow access to your records at any time, and make payments online
• Insurance claims appeals and re-filing
• Account resolution up to and including speaking with human resources and insurance companies if needed on a case by case basis
• Billing summaries for FSA/tax purposes

Realizing that growing families may have limited budgets, we have set our annual Non-Covered Services Fee at $80 per child, with a maximum of $210 per family (3 or more children). Please note that this is far less expensive than paying for each service as you request it. We look forward to continuing to provide you these services upon request. If you have any questions, please contact Melissa Delarosa in the Fairfax office (703) 356-7882.

Thank you.

Forms

New Patient Packet (print and complete the forms below)

Wellness Pediatrics Patient Medical History Form

Wellness Pediatrics Patient Medical History Form (Español)

 Wellness Pediatrics Patient Registration Form

 Wellness Pediatrics Patient Registration Form (Español)

Virginia School Entrance Health Form

HIPAA Form

HIPAA Form (Español)

Virginia Sports Form

Medication Authorization Form

Epinephrine Authorization Form

Inhaler Authorization Form

Our patient portal offers a secure and convenient access to your health care information.

Patients can access features such as:

• TeleVisit User Guides & Access
• Exchanging secure messaging with providers
• Viewing lab results online
• Managing payments with ease
• Reviewing appointments
• Access to view and print immunization records

Insurance

We are providers for most major health insurance plans. If you have questions, please contact your insurance carrier or our office for more information. Currently we participate with the following plans:

Insurance Plans

Click Here For Listing

• Aetna
• Anthem
• Anthem HealthKeepers
• Anthem HealthKeepers Plus
• Blue Cross Blue Shield
• CareFirst
• Cigna
• Coventry
• First Health Network
• GEHA
• Golden Rule
• HealthLink PPO
• Innovation Health
• In Total Health
• Kaiser Permanente (PPO)
• MAMSI
• Meritan Health
• MultiPlan Network
• NCPPO
• One Net PPO
• Optimum Choice
• PHCS Network
• Southern Health
• Trigon
• United Healthcare
• UMR
• Virginia Medicaid
• WellNet

Office Closings

Both offices will be closed on:

New Year’s Day

Memorial Day

Fourth of July

Labor Day

Thanksgiving Day

Christmas Day