Holly City Pediatrics

New Patients

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Welcome to the Team!

Thank you for considering our practice! Feel free to stop by the office to meet the doctors and staff. If you are already convinced that we are right for you and want to spend less time in the waiting room (who wouldn't), then please fill out the New Patient Form below and click submit.

 

Accepted Insurance:

All major insurance providers are accepted with exception to the following: Amerigroup, Wellcare, and AetnaBetter Health.

 

Below you will find a copy of our office policies, effective January 2019.

Please take a moment to read them over. Printing the form to bring to your first appointment is optional, but you will be asked to sign a copy at that visit.

New Patient Form

Note: Please complete this form in one sitting. If you click the back button before clicking submit, all parts filled out will be deleted