Connecticut Pediatric Otolaryngology

 

230 Boston Post Road            Yale Children’s Hospital        11 Peck Street

Madison, CT  06443               1 Park Street                           North Haven, CT  06473

(203) 245-0496                       New Haven, CT  06511          (203) 234-8199

(203) 245-8697 - FAX                                                            (203) 234-6767 - FAX

 

Dear Parent/Guardian,

 

We would like to welcome you to our practice.  Your child has an appointment with

_____________________________on __________at ______ in our ________________office.

 

Please review the enclosed information prior to your appointment.  The Patient Registration and Medical History form is a very important piece of your child’s medical record.  Please complete it as accurately and as completely as possible.

 

What to bring to your appointment:

  • The Patient Registration and Medical History Form;
  • Your child’s health insurance card;
  • A referral or authorization number from your Primary Care Physician, if required by your insurance plan;
  • Any co-payment required by your insurance carrier (cash, check or Mastercard/Visa credit cards);
  • Films from x-rays and CT scans, if appropriate; and,
  • Results from any applicable diagnostic tests (hearing test, sleep studies, etc).

Insurance Information:

We make every effort to coordinate payment for your visit with your insurance carrier. It is your responsibility, however, to provide us with accurate, up to date information which will assist in the collection process.  All claims that are denied by the insurance carrier are the responsibility of the patient/guardian.  If your insurance plan requires a referral from the Primary Care Physician, please bring the referral with you or have your doctor call us or fax a copy prior to your visit.  Your visit will be rescheduled if the referral is not on file at the time of your appointment.

Contacting us:

If you have any questions about your appointment or if you need to change your appointment, please call (203) 245-0496 as soon as possible.  If you are having an urgent medical problem and need to speak to a physician, call (203) 785-2591.

 

You can help us provide the best care possible by arriving for your appointment on time and by bringing all the information listed above.  We are looking forward to seeing you and your child. 

 

Sincerely,

 

David E. Karas, M.D.     Eric D. Baum, M.D.      Alyssa R. Terk, M.D.

Wendy Mackey, A.P.R.N.      Lisa Gagnon, A.P.R.N.