For Our Patients

Downloadable forms (in PDF format)

We encourage you to print out the appropriate forms from the list below, fill them out at your leisure in the comfort of your own home or office and then simply bring them with you to your visit. This will save valuable time when you arrive for your appointment.

Forms and More Forms!
College, School, Camp, Sports Forms

During the spring and summer months, Candlewood Valley Pediatrics will be filling out hundreds of Camp and School forms. It is always best to bring your form to your child’s checkup, where it will be filled out and signed during the visit, so there will be no waiting and no fee.

Forms that are requested outside of a checkup visit take up to five days to complete and require the signature of the patient’s provider (there is no charge for a non-urgent form). Forms are filled out in the order they are received. Beginning in October, if you need a form completed in less than 48 hours from when it is requested, there will be a $5 fee because we are putting that form first and completing it ahead of the forms that have been waiting. There are circumstances under which the expediting of a form will not be possible; you will be informed of that at the time of the request.

Please make sure to complete your portion before submitting the form to our office. Please PLAN AHEAD.

Privacy and the Health Insurance Portability and Accountability Act (HIPAA)

For your convenience and information, our Notice of Privacy Practices (HIPAA) is available in PDF format. Please take a few moments to review this notice. Acknowledgement of Receipt of the Notice of Privacy Practices is included in the Waiver and Acknowledgement form found above.

Appointments

For our patients' convenience, Candlewood Valley Pediatrics (CVP) offers daily, evening and Saturday appointments (Saturday hours are reserved for sick patients only). We are also open on several federal holidays​. Please note that the CVP physicians are on call 24 hours a day, 7 days a week.

Appointments for any of the following types may be made by calling the office at (860) 355-8190.

  • Well Patient Visits
    You may schedule a well patient visit up to six months in advance. When you schedule an appointment for a checkup, we will make every effort to schedule you with the provider of your choice. This is not always possible, however, depending on your schedule and the providers' schedules. Spring and summer are busy months, so we ask that you plan ahead.
  • Scheduled Sick Visits
    Appointments for sick visits are scheduled during regular office hours. We encourage you to call as early in the day as possible. Although we will make every attempt to schedule your child's visit with the provider of your choice, your schedule and the providers' schedules may not always permit this. If your child's condition changes before your scheduled appointment, please call the office immediately at (860) 355-8190.
  • Sibling Visits
    Should you have an appointment with one child and wish to have a sibling checked at the same time, please call and notify the office so that time can be made available to accomplish this.
  • Parent Seeking Advice
    If the parent or guardian feels that it is necessary to meet with a provider to discuss a rather complex or difficult issue regarding a child's health or behavior, the office staff will ask the provider to contact the parent/guardian to schedule a time for a conference.
  • Weekend Appointment
    Weekend hours are reserved for sick children. The office staff will schedule Saturday appointments with the Candlewood Valley Pediatrics physician who is on call for that weekend. Our answering service will forward Sunday calls to the on-call provider, who will return your call promptly.

The telephones are answered by our office staff during the following times:
(please note that we are closed from 12:45 pm – 1:45 pm)

  • Monday through Thursday, 8:00 am - 5:45 pm
  • Friday, 8:00 am - 4:30 pm
  • Saturday mornings

If you have an emergency, or need to speak to the physician on call, the answering service will contact the physician on call for you.

Patient emergencies sometimes occur that may interrupt the normal appointment schedule. If a delay is likely to result because of an emergency, we will contact you as soon as possible and either reschedule your appointment with a different physician, or reschedule the appointment at a time that is most convenient for you.

As a courtesy to our patients, our office attempts to contact every patient to remind them of their appointment. However, it is your responsibility to make a note of your child’s upcoming appointment, and to arrive for the appointment on time.

A fee will be charged for any appointment not cancelled by 3 pm of the previous day, or by 3 pm on the Friday before a Monday appointment.

When a patient does not show as scheduled, three people get hurt:

  • Your child, because they won’t get the care they need as prescribed by their physician
  • The physician who now has a space in their schedule since the time was reserved for your child personally
  • Another child who could have been scheduled if there had been proper notice

These fees are not covered by insurance and, therefore, you will be responsible for payment.

No show/cancellation Fee Schedule

Sick visit appointments = $25.00
Physical appointments = $50.00

Parental Rights

If there is a change in your child’s parental rights and medical decision making status, please inform the office and submit that legal documentation to be scanned into your child’s chart.

Vaccination Policy

We follow the recommended immunization schedule for the American Academy of Pediatrics. We require all of our patients to be up to date with vaccines at the following ages: 2 years, 6 years, and 13 years.

Statement on the Use of Marijuana

At Candlewood Valley Pediatrics, we neither condemn nor condone the use of medicinal or recreational marijuana in your home.

By law, we are mandated reporters of any suspected abuse or neglect by caregivers. At times, this may include the use of marijuana, including if a caregiver is suspected of driving while under the influence.

If you or your child comes in smelling like marijuana, this may be cause for concern and may lead to staff reporting you to the Department of Children and Families (DCF).

Understand that we must follow the letter of the law regarding mandated reporting. Our license depends on it, as does the welfare of all the children we care for.

If you choose to use marijuana, do not drive with your child in the car. If you choose to use marijuana, ensure your child can in no way access it or any paraphernalia for their own safety. You will be reported to DCF if your child is found in possession of any drugs or drug paraphernalia on our premises, even if it is a legal substance.

We love our families and love caring for your children. We never want to be faced with reporting suspected abuse or neglect, but it is our job to keep all children safe.

We appreciate your full cooperation.

 

Thank you.

Insurance & Billing Information

Candlewood Valley Pediatrics participates with most major insurance companies. Important criteria on which we base our decisions are the availability of specialists in the referral network and on the needs of our patients and community.

There are many rules, regulations and limitations imposed by each insurance company, and further within the different plans offered. The specific benefits negotiated with these insurance companies by individual employer groups make it impossible for us to navigate through their networks. We ask that you become familiar with your specific plan and the benefit package that has been chosen for you and your family.

It is important for you to understand that our providers recommend treatment based on the individual needs of each patient. There may be times that your insurance company may not pay for these visits and/or procedures that can be associated with the visit. Please understand that our main concern is for your child, and our responsibility is to provide the best possible medical care for him/her. We do not base our medical decisions on the stipulations of the insurance companies.

We will gladly file your insurance for you. Some of these insurance plans are based on deductibles and pay a percentage of the charges. Again, we urge you to contact your individual insurance company and to familiarize yourself with your policy.

Our Billing Staff is available to assist you with any questions or concerns that you may have with respect to your account.