Today's Date:


New patient

Patient info

Medical history

Consent to treat


Notice of privacy practices

Financial policy

Parent Resources

Medical records request from Becker Pediatrics

Medical records request to Becker Pediatrics


In cases of divorce, the parent bringing the patient in for care is responsible for payment of co-pays, coinsurance and non-participating insurance balanoes at the time of service. Parent or legal guardian bringing a child in for treatment is responsible for all co-pays, deductibles and co-insurance at the time of service.


The parent with primary custody is usually the parent with whom the child lives and who usually brings the child to the practice for care. The custodial parent is responsible for payment at the time of service whether the account is considered self-pay, participating insurance or nonparticipating insurance. If the noncustodial parent carries the insurance on the child, the practice will bill that insurance company, The practlce does not get involved with divorce specifics, e.g., one parent pays 80% and the other pays 20%. It Is. the parents' obligation to work out an agreement themselves or through the court system.


Before your child's first appointment, please have all previous medical records sent to us. We participate with most insurance plans, and accept payment by check, cash, or credit card. Payment is due at the time of visit.