Forms

Policies & Forms

New Patient Registration

Please click on the link below to help prepare you for your first visit with us. We look forward to meeting you!

Forms

No Show And Cancellation Policy

$25 will be charged to all patients who do not provide 24 hour notification to cancel a scheduled well-check appointment or for patients who do not show for their scheduled appointments.

Financial Policies

Please review the forms below and sign. A credit card on file is required for all non Sooner Care patients. Patient financial information will be kept in a secure file.

Financial Policies and Procedures Form
Insurance Form
Credit/Debit Card Pre-authorization Form

Financial Policies and Procedures Form

Insurance Form

Credit/Debit Card Pre-authorization Form

Consent To Treat

Consent to Treat Form

A Credit Card On File Is Required For All

Peace of Mind Pediatrics requires patients to pay any cost shares (copays, deductibles, coinsurance) in full at the time of service. We accept cash, checks, and major credit/debit cards. Please get in touch with our billing office with any questions about your insurance benefits or balances due."

Office Hours

Monday

8:00 am - 7:00 pm

Tuesday

8:00 am - 5:00 pm

Wednesday

8:00 am - 5:00 pm

Thursday

8:00 am - 5:00 pm

Friday

8:00 am - 5:00 pm

Reliable Tips from the American Academy of Pediatrics

Get In Touch With Us

Give yourself confidence in your children’s healthier future. Peace of Mind Pediatrics is your best choice for your children’s pediatric care. Our patients come to us from all over the greater OKC area including: Choctaw, Mid-Del area, Edmond, Yukon, Harrah, Moore, Newalla and Shawnee.
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