Uptown Office: 450 West End Avenue • New York, NY 10024 • 212-769-3070 • Fax: 877-451-0227

Downtown Office: 2 Fifth Avenue • New York, NY 10011 • 212-353-0072 • Fax: 877-451-0227

Uptown Office: 450 West End Avenue • New York, NY 10024 • 212-769-3070 • Fax: 877-451-0227

Downtown Office: 2 Fifth Avenue • New York, NY 10011 • 212-353-0072 • Fax: 877-451-0227

Payments

Fees:
We do not accept insurance. Fees for our services are charged directly to the patient (or guarantor) and payment is due at the time of service. We do not bill your insurance carrier but at your request, we will provide you with an invoice at each visit so that you may file a claim. All fees due are the responsibility of the parent/guarantor.

Missed Appointment: $75 - Well visit (24 hour advanced notice is needed for cancellation)
$25 - Sick visit (2 hour advanced notice is needed for cancellation)
School/Camp Form: Free at time of physical.
Returned check: $30 each
Collection charge: Individual
After-hours Surcharges: Services rendered outside of our standard business hours may be billed with surcharges. Surcharges may apply to walk-in hours, late physicals and weekend/holiday visits. If late physical appointments are missed, the full physical fee will be charged.
Statements: Your statement is mailed once a month and indicates your balance.
Payment is due within 15 days from receipt of the statement.
*A balance 30 days past due is subject to an 18% annual interest charge.

COLLECTIONS POLICY
If you are unable to pay your balance on time, we will do our best to assist you with an individual payment plan. If a guarantor chooses not to work with us cooperatively to settle an overdue account, we may place the account with a collection agency.

Patients whose accounts are referred to a collection agency or law firm are required to pay the costs of collection as well as the unpaid balance in order to remain a patient of our practice.

We reserve the right to discontinue our services if your account is placed in collection or with a law firm. In that event, we will send you a medical records release so that you may transfer care and records to a new physician.