Forms
Quickly and conveniently obtain forms from our office.
- Preferably, access our digital forms here to complete and submit via confidential, HIPAA compliant email directly to our office.
- If you would prefer to download and print your forms, you are welcome to fill these out at home and bring them with you to your appointment.
To view the forms listed below, you will need Adobe Reader. You may download Adobe Reader for free at http://get.adobe.com/reader.
Registration Packet
All of our forms are located within these two files. You may download, print out, and fill out the necessary forms to bring into the office.
Insurance Information
Young Pediatrics participates in the following insurance plans (as well as other smaller plans, please call for verification):
- Aetna/ US HealthCare
- Beech Street
- Berkshire Health
- Blue Cross/Blue Shield HMO/PPO – IL
- Blue Cross/Blue Shield HMO/PPO – MO
- Cigna PPO and HMO
- GHP
- Great West Health Plan
- Healthlink HMO/PPO
- Tricare
- Unicare
- United Health Care
- Most Illinois Medicaid Programs
Please remember to contact your insurance company directly about preferred providers and coverage for copays, specific labs or hospital groups they prefer, immunization coverage, and the need for prior authorization for procedures and sub-specialty appointments. Every plan is different, even within the same company. Be sure to know your plan!
Insurance Tips:
- Be sure to notify your insurance company about any newborns!
- It is vital that you have your new baby added to your policy during the stated grace period. With most insurance companies this gives you thirty days from the date of birth to have the baby added or they will deny your claims back to the the babies date of birth.
- We will ask you for a copy of your insurance card at your initial visit in order to verify your current insurance coverage. If your insurance coverage changes, please have your new insurance cards available at the time of the visit.
- Find out if your insurance plan covers immunizations 100%.