Parental Consent Protocol

• It is the policy of Pediatric Ear, Nose & Throat Associates, P.C. that each patient is to be accompanied to their first visit in our office by their parent or legal guardian. (If legal guardian brings child in, the MUST present appropriate paper work.)
   
• If the patient is an established patient of Pediatric Ear, Nose & Throat Associates, P.C. and is coming for a routine recheck appointment with our office, they can be accompanied to the office WITH consent of parent or legal guardian, by grandparent, emergency contact or whomever the parent/legal guardian deems responsible. **NOTE: Whoever is accompanying the patient into PENTA must present notarized paperwork stating that they have been given permission for said person to accompany the patient into the office. (We will need to obtain photo ID from the person that has accompanied the patient.)
   
• Should the patient be an established patient of PENTA yet their chart be in storage this will make the patient a NEW patient and they will need to be accompanied by their parent or guardian to their NEW patient appointment.
   
• Should the patient be an established patient of PENTA and be coming into the office for a NEW problem, they will need to be accompanied by their parent or legal guardian.

PLEASE BE ADVISED: ALL PARENTS ASKING IF SOMEONE ELSE CAN BRING THEIR CHILD TO RECHECK APPOINTMENTS THAT ARE PROCEDURES, SURGERIES, CT SCANS, ETC. CANNOT BE SCHEDULED UNLESS THE PARENT OR LEGAL GUARDIAN ARE PRESENT AT THE APPOINTMENT.

Payment Policy

Co-payments and deductibles are due at the time of your appointment. Failure to pay your co-payment or deductible may result in the rescheduling of your appointment.

If surgery or a procedure is scheduled, fifty percent (50%) of the patient responsibility will be collected prior to the date of the surgery/procedure.

Self-pay patients are responsible for paying the full amount the date the service is rendered.

Any additional patient responsibility must be paid in full by the time line shown below:

Should you have any questions about our payment policy or if extenuating circumstances do not allow you to follow the terms, please let us know. We will be happy to discuss payment options with you on an individual basis.