Policies & Forms
Learn about the policies that help us provide your children with the very best of care.
Office Forms & Downloads
New Patient Forms (Under 18 Years)
- Please review, complete and submit each of these forms before your first visit. These forms are for patients under 18 years of age.
- Patient DemographicsComplete once for each patient.
- Patient Medical HistoryComplete once for each patient.
- Texas Immunization Registry Minor ConsentComplete once for each patient.
- Authorization/Consent to Treat MinorComplete once for each family.
- Financial PolicyComplete once for each family.
- Notice of Privacy PracticesComplete once for each family.
- Medical Records ReleaseComplete this form to transfer your children's medical records to Arbor Pediatrics.
New Patient Forms (18 Years and Older)
- Patients 18 years and older must review, complete and submit each of these forms.
- Patient DemographicsComplete for new patients only.
- Patient Medical HistoryComplete for new patients only.
- Texas Immunization Registry Consent
- Authorization/Consent to Treat Over 18
- Financial Policy
- Notice of Privacy Practices
- Medical Records Release
Other Consent Forms
- Flu Vaccine ConsentTo be completed by a parent or caregiver.
School & Sports Forms
- Texas UIL Physical Evaluation FormThis form must be completed annually by parent (or guardian) and student in order for the student to participate in activities.
- Texas UIL Athletics Forms
- Carroll ISD Athletic Online Forms
- Carroll ISD Medication & Health Forms
- GCISD Athletics Forms
- GCISD Medication & Health Forms
- Keller ISD Athletics Forms
- Keller ISD Medication & Health Forms
Insurance & Billing Policies
We are committed to providing you and your children with the highest caliber of care. As part of your relationship with Arbor Pediatrics, a clear understanding of our financial policies is important so you will know what actions we will be undertaking on your behalf, as well as what your financial responsibilities are to Arbor Pediatrics.
It is Your Responsibility
- To know the limits and coverage of your particular health insurance policy
- To show your cards to us at each visit
- To pay any copays at the time of service
Our billing staff will do their best to assist you with insurance questions; however, if you have questions about your coverage, it is best to check with your specific insurance company.
Autopay
As a convenience to our patients and to simplify the billing process, we require the use of autopay, which is a credit card on file. Learn more by reading our complete financial policy.
We Accept Most Insurance
As a courtesy to our patients, we will file the necessary forms so that you receive the full benefits of your medical coverage. We ask that you read your insurance policy to be fully aware of any limitations of the benefits provided. If your insurance company denies coverage or determines that a rendered service is not a covered benefit of your plan, you are responsible for the remaining balance.
Self Pay Accounts
We are happy to work with families that prefer to pay directly for services or do not have insurance. For such patients, a time of service discount will be applied to the bill if settled in full on the day of service. Read our financial policy for complete details.
Administrative Fee
We provide unlimited form completion for school/camp/sports, medical letters of necessity, non-medical insurance forms such as FMLA, disability, life and other administrative services. To cover the cost of this and other services are not covered by insurance, we assess an annual administrative fee of $25 per patient.
Appointments Are Required
We make every effort to meet the needs of our patients by offering routine well and sick visits, as well as telemedicine visits. We offer same-day sick appointments when at all possible – call or text the office to schedule a visit.
We do not offer walk-in visits.
Late Arrivals
We make every effort to run on time, as we believe everyone’s time is equally valuable. If you are later than 10 minutes for your appointment, you will be offered the next available appointment time. Out of courtesy to our other patients, we may ask you to reschedule your appointment.
Cancellations
Please make appointment changes no later than 24 hours (1 business day) before your appointment. Appointments that are missed or cancelled without 24-hour notice are assessed a $50 fee for sick visits and a $75 fee for checkups. Appointments that are scheduled for the same day and then cancelled or missed will be charged $50.
After-Hours Care
If your child’s illness or injury is life threatening, call 911. This includes loss of consciousness, severe bleeding, seizure, etc.
For urgent matters that cannot wait until morning, please contact Dr. A before 10pm using Spruce, our texting platform. The doctor will respond and based on the situation, a telemedicine visit may be required.
After 10pm, calls will be directed to a nurse on call service. Please save routine questions (mild illness, appointments, prescription refills) for the morning.
Expert Advice
Our collection of over 800 parent education handouts from the American Academy of Pediatrics offers helpful information organized by topic and symptom. You may wish to consult this resource before contacting us after-hours.
Additional Fees
Business hours at Arbor Pediatrics are weekdays 8am – 5pm. Services rendered outside of these times are considered after-hours, and may incur additional fees not be covered by your insurance policy.
Vaccines save lives.
We firmly believe, based on all available literature, evidence, and current studies:
- In the effectiveness of vaccines to prevent serious illness and to save lives.
- In the safety of our vaccines.
- That all children and young adults should receive all of the recommended vaccines according to the schedule published by the Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP).
- That vaccines do not cause autism or other developmental disabilities.
- That thimerosal, a preservative that has been in vaccines for decades and remains in some vaccines, does not cause autism or other developmental disabilities.
- That vaccinating children and young adults may be the single most important health promoting intervention we perform as health care providers, and that you can support as parents/caregivers.
The recommended vaccines and the schedule of administration are the results of years and years of scientific study and data-gathering on millions of children by thousands of our brightest scientists and physicians.
The vaccine campaign is truly a victim of its own success. It is precisely because vaccines are so effective at preventing illness that we are even discussing whether or not they should be given. Because of vaccines, many of you have never seen a child with polio, tetanus, whooping cough, bacterial meningitis, or even chickenpox, or known a friend or family member whose child died of one of these diseases. Such success can make us complacent about vaccinating. But such an attitude, if it becomes widespread, can only lead to tragic results.
As medical professionals, we feel very strongly that vaccinating children on schedule with currently available vaccines is absolutely the right thing to do for all children and young adults. We are making you aware of these facts not to scare you or coerce you, but to emphasize the importance of vaccinating your child. We are more than willing to discuss any questions you may have about vaccines, but do require all new patients to our practice to adhere to the vaccination schedule endorsed by the American Academy of Pediatrics (AAP).
Resources
- Immunization ScheduleCenters for Disease Control and Prevention (CDC)
- Vaccine Information StatementsCenters for Disease Control and Prevention (CDC)
- Vaccine Safety: The FactsAmerican Academy of Pediatrics
- COVID-19 Vaccine: Frequently Asked QuestionsAmerican Academy of Pediatrics
- VaccinateYourFamily.orgHelping to protect people of all ages from vaccine-preventable diseases
- National Network for Immunization Information
- Institute for Vaccine SafetyJohns Hopkins Bloomberg School of Public Health
- Centers for Disease Control (CDC)
- Immunize.orgFormerly Immunization Action Coalition (IAC)
- Vaccine Education CenterChildren's Hospital of Philadelphia
“They go above and beyond!”
Finding a pediatric office that you and your family love can be difficult. Needless to say, my family and I found a place we love coming to. Everyone here is friendly, kind, professional, and considerate. They go above and beyond and they’re genuine with how they treat and care for families. I would definitely recommend them to everyone I know.
“I wish all my family’s healthcare providers ran this smoothly!”
Arbor Pediatrics is outstanding! Their instant messaging app allows parents to easily communicate with them which improves patient care. I wish all my family’s healthcare providers ran this smoothly! Recently, they accommodated a same day sick call appointment eliminating a trip to urgent care.
“Dr. Asgoankar is a top notch doctor”
Wonderful pediatric office with caring staff. The facility is warm, friendly and inviting. Dr. Asgoankar is a top notch doctor, able to work with infants through teens. My daughter loves her!
Arbor Pediatrics
Office Hours
Monday - Thursday
8:00 am - 12:00 pm
1:00 pm - 5:00 pm
Friday
8:00 am - 12:00 pm
1:00 pm - 3:00 pm
We require an appointment for your child to be seen. Please contact the office via text or phone to make an appointment or to speak with our team.
After-Hours Care
If your child’s illness or injury is life threatening, call 911.
For urgent matters that cannot wait until morning, please contact Dr. A before 10pm using Spruce, our texting platform. The doctor will respond and based on the situation, a telemedicine visit may be required.
After 10pm, calls will be directed to a nurse on call service. Please save routine questions (mild illness, appointments, prescription refills) for the morning.
Poison Control Hotline
(800) 222-1222
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