List
of additional charges
(as of November 2010)
Saturday/Sunday/holiday charge -- $55
Consultation letters / reports -- $15-$25
Early Intervention Form -- $25
Forms needed within 48 hours -- $15 in addition to any other fees incurred
No-show fee, doctor appointment -- $25
(24 hour notice must be given for cancelled appointment)
No-show fee, nurse appointment -- $25
(24 hour notice must be given for cancelled appointment)
Copy of chart fee -- $15 per child
Bounced check fee -- $20
Co-pay not paid at time of service -- $10
Fee for bills not paid within 30 days (starting October 1, 2005) -- $10 per month
Physical exam form (school/camp, etc.) -- A Universal Form will be filled out at time of annual physical exam and provided free of charge. Patients must make additional copies of this form for their own records. Any duplicate or additional forms are $5 each
Allergy & Asthma Forms – There will be a $10 charge for each allergy and asthma form that is filled out.
Sports Physical Form -- There will be a $10 charge for sports physical forms that are required by the State of New Jersey. If the sports form is not filled out at the physical, there will be a $20 charge.
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