Policies & Forms

Learn about the policies that help us provide your children with the very best of care.

Forms &
Downloads Office
Policies Insurance
& Billing After-Hours
Care Vaccination
Policy Privacy
Policies

Patient Forms & Downloads

Please bring your completed forms with you to our office at the time of your visit. All forms and documents are in PDF format.

New Patient Forms

Please download and complete these forms before your first appointment.
Patient Registration (under 18)
Patient Registration (18 and over)
Release Medical Records to KBP
Office and Financial Policies
Notice of HiPAA Privacy Practices

Policy Documents

Consent & Release

Office & Appointment Policies

At Kaplan Barron Pediatrics (KBP), our goal is to provide high-quality, timely, and compassionate medical care for all children and families. To maintain a safe and efficient environment for our patients and staff, we require all families to follow the policies outlined below. Download our complete policy here.

Appointments and Walk-Ins

We offer walk-in sick visits on weekday mornings on a first come, first served basis for established patients 2 months of age and older. Otherwise, patients are seen by appointment only. Please call our office to schedule your child’s appointment anytime during our normal business hours.

Mutual Respect for Time

Appointment Scheduling & Respect for Time

KBP strives to stay on schedule and provide timely care. Occasionally, emergencies may delay scheduled visits. We appreciate your understanding when this occurs.

To help reduce wait times, we ask that families follow these expectations:

Arrive 10 minutes early to allow time for check-in and paperwork.
Patients arriving 10 minutes or more late may need to reschedule.
If you want additional children seen at the same visit, please notify the office in advance.
If you are running late, please call. We may be able to accommodate you depending on the day’s schedule.

Cancellations & No-Shows

Cancellation and No-Show Policy

Missing an appointment without notice prevents other patients from receiving care. To help us provide timely access for all families, KBP requires the following notice:

Well visits: 24-hour notice required to cancel or reschedule
Sick visits: 2-hour notice required to cancel or reschedule

Failure to provide proper notice will result in a no-show fee per child, as outlined below:

No-Show Fees

Sick visit: $30.00
Well visit / Physical: $50.00
ADHD / Anxiety visit: $75.00
Mental health (60 minutes): $100.00
Mental health (30 minutes): $60.00
Additional Saturday no-show fee: $25.00

Because Saturday appointments are limited and in high demand, weekend no-shows may carry additional charges.

Repeated No-Shows

Three (3) no-show appointments in one year may result in dismissal from the practice.
Saturday no-shows may result in loss of future Saturday scheduling privileges.
New patients who do not show for their first appointment will not be scheduled again.

Chronic Medical Conditions

Chronic medical conditions require routine monitoring to ensure safe and effective care. Conditions may include (but are not limited to):

ADHD
Asthma
Anxiety
Depression

ADHD medication management: Patients must be seen every 3 months once stable on medication.

Other chronic conditions require follow-up every 3–6 months, depending on the child’s treatment plan.

Medication refills will not be provided if the patient is overdue for required follow-ups and/or annual well visits.

Well Check-Ups

Routine well child visits are essential for monitoring your child’s growth, development, academic progress, and behavioral health. These visits allow us to identify concerns early and provide appropriate treatment and guidance.

Per the American Academy of Pediatrics (AAP), preventive visits are recommended at the following ages:

3–5 days old
1 month
2 months
4 months
6 months
9 months
12 months
15 months
18 months
24 months
36 months
Annually from ages 3 through 21

Parents/guardians are expected to follow these guidelines to remain established in our practice. Failure to stay current with preventive care may result in dismissal from the practice.

Please note: School, daycare, and other forms will not be completed for patients who are not up to date on well check-ups.

Prescription Refills

Medical Records & Forms

Transfer of Medical Records

Requests for transfer of medical records can be submitted through the patient portal. When transferring to another provider, please include the name and destination of the receiving office.

School Forms and Paperwork

School, sports, daycare, and camp forms are completed free of charge when submitted at the time of a well visit. Parents must complete all parent/guardian sections of forms before submitting them to our staff.

Form Fees

Standard forms outside of well visits: $15 (2–3 business day turnaround)
FMLA forms: $35 (up to 7 business days)
Rush same-day forms (not submitted at a well visit): $35

Behavior Policy

Kaplan Barron Pediatrics is committed to providing a safe and respectful environment. The following behaviors will not be tolerated in the office, by phone, or through electronic communication:

Verbal abuse, yelling, threats, or harassment toward staff or other patients
Profanity, racial slurs, discriminatory language, or inappropriate gestures
Physical aggression, intimidation, or violence
Threats of harm toward staff, providers, patients, or property
Disruptive behavior that interferes with patient care or office operations
Repeated refusal to follow staff direction or office policies
Destruction of office property
Unsupervised children causing disturbances or damage
Recording staff or patients without permission

Kaplan Barron Pediatrics reserves the right to discharge a patient and/or family from the practice due to inappropriate, disruptive, or repeated unacceptable behavior.

Divorced/Separated Parents

We understand that divorce and separation can create difficult family dynamics. However, KBP must remain neutral and focused on the child’s medical care.

Our office will not mediate parental disputes or provide legal guidance.
Parents are responsible for communicating directly with one another regarding their child’s care.
Unless legal documentation states otherwise, we will assume joint custody and equal access to medical records.
Visit summaries are available through the patient portal.
Appointment reminders will only be sent to the primary phone number listed on the account.
We do not contact the non-attending parent after appointments.

Copays are required at the time of service and are the responsibility of the parent/guardian attending the appointment. A receipt may be provided upon request.

If parental conflict disrupts care or interferes with office operations, KBP reserves the right to dismiss the family from the practice.

Insurance & Billing

We are committed to providing the best possible care and service to you, and appreciate your understanding of your financial responsibilities as an essential part of your child’s care. If you have any questions concerning these policies, please contact our office.

Read Our Financial Policy Pay Your Bill

Billing Your Insurance

Please present a current insurance card at every visit.
KBP will bill your verified primary insurance as a courtesy.
Any copays, coinsurance, or deductibles are due at the time of service.
Patients without insurance must pay in full at the time of service.
- A time-of-service discount may apply if payment is made in full on the day of the visit.
- Discounts do not apply after the date of service.

It is the patient’s responsibility to understand their insurance plan, covered services, and limitations. Some insurance plans do not cover annual well visits if the visit occurs fewer than 365 days from the last preventive visit. If your plan does not cover the visit, you are responsible for payment.

Accepted Insurance

We accept the following insurance providers. If your insurance company is not listed here, please call us for more information.
Aetna
Aetna Better Health
Anthem/Blue Cross Blue Shield
Cigna
Humana
Humana Medicaid
Passport/Molina
Tricare
United HealthcareExcluding UHC Medicaid
Wellcare

Payments and Fees

Copays, coinsurance, and deductibles are due at check-in.
Statements are mailed weekly, and payment is due upon receipt.
Past-due accounts may delay scheduling future appointments until payment arrangements are made.

Returned Checks

A $35 fee will be charged for returned checks. Payment for the check amount plus the returned check fee must be made within 10 days. Future payments must be made by cash or credit card.

Collection Accounts

Accounts unpaid for more than 90 days may be referred to a collection agency. If an account is sent to collections, a 40% surcharge will be added to the balance. Patients sent to collections may be asked to establish care elsewhere.

Well Visits and Testing

Some insurance plans do not cover annual well visits if the visit occurs fewer than 365 days from the last preventive visit. If your plan does not cover the visit, you are responsible for payment.

Your insurance may not cover certain in-office testing, including but not limited to:

Hemoglobin testing
Surveys and hearing and vision screenings
Strep testing
COVID testing
Mono testing
Molecular tests
Respiratory panels
RSV testing
RSV monoclonal antibody vaccine
Ear wax removal

If testing is performed and your insurance does not cover it, the balance will be the patient’s responsibility.

After-Hours Care

If your child’s illness or injury is life threatening, dial 911.

Otherwise, for urgent matters that cannot wait until business hours, please call our office at 502-452-6337 to speak to a triage nurse, who may connect you with the doctor on call.

Poison Control Hotline
(800) 222-1222

Suicide & Crisis Lifeline
Dial/Text/Chat 988
www.988lifeline.org

Hospital Affiliations

Our doctors are affiliated with these Louisville hospitals: Norton Children’s Hospital, Norton Hospital, Norton Suburban Hospital, Baptist Hospital East.

Health Education Tools

Symptom CheckerUse this symptom checker to learn how serious your child’s symptoms are, whether you need to see the doctor, and how you can provide relief.
Dosage CalculatorBe confident that you are treating your child with the correct dose of Tylenol, Motrin, or Benadryl.
Parent AdviceHelpful advice on dozens of topics, from sleep and toilet training to behavior and nutrition.
First AidValuable step-by-step guidance for everything from a sprained ankle to a lost tooth.
Health & Wellness WebsitesOur recommendations for accurate online resources you can trust.

Vaccines Save Lives

Vaccines are safe and effective in preventing serious diseases and long-term health complications. Kaplan Barron Pediatrics requires all patients to follow the current immunization schedule recommended by the American Academy of Pediatrics.

To protect our patients—especially infants and medically fragile children—KBP does not accept families who choose not to vaccinate.

Families with vaccine concerns are encouraged to discuss questions directly with the provider. However, if your family ultimately decides not to vaccinate, we will ask you to establish care with another pediatric office that better aligns with your beliefs.

Resources

Immunization ScheduleAmerican Academy of Pediatrics (AAP)
Vaccine Information Statements
Vaccine Education CenterChildren's Hospital of Philadelphia
Vaccine Safety: The FactsAmerican Academy of Pediatrics
VaccinateYourFamily.orgHelping to protect people of all ages from vaccine-preventable diseases
Institute for Vaccine SafetyJohns Hopkins Bloomberg School of Public Health
Immunize.orgFormerly Immunization Action Coalition (IAC)

Website Disclaimer & Privacy Policies

Website Disclaimer

Any use of this website or the information contained in the website is at your own risk. We will not be responsible for the consequences of your decision to utilize the information contained in this website.

The medical information provided in this site is for educational purposes only, it is not intended nor implied to be a substitute for professional medical advice. Always consult your physician or healthcare provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

Privacy Policy

We are committed to the right to privacy for our patients and website visitors. When a person visits our website we may collect and track data from our site’s server. This information helps us to improve on the content provided on our site. Information collected may include how long you spend on our site, the pages you visit, your browser and operating system types and the name of your internet service provider.

Our website provides the capability to request information on-line. To process your request, we may require that you provide us with personal identifying information. All information collected is held in complete confidence. It is our policy not to share the information with third parties for any reason, unless legally required to do so or as necessary to process your requests.

If you have any questions about our privacy policy or our use of information gathered through our website, please contact us.

Notice of HiPAA Privacy Practices

Contact Us

4117 Browns Lane
Louisville KY 40220

Map & Directions

Phone
502-452-6337

Fax
502-458-5327

Open House Visits

To help us become acquainted with new families, we hold an Open House on the third Thursday of each month from 6:00 pm – 7:00 pm. Please call us to sign up, we look forward to meeting you!

Open House Schedule

Office Hours

Monday –Thursday
8:00 am - 6:00 pm

Friday
8:00 am - 5:00 pm

Saturday
8:30 am - 1:00 pm

Sunday
Closed

Walk-In Sick Visits

We offer walk-in sick visits on weekday mornings and afternoons on a first come, first served basis for established patients 2 months of age and older. Find out which conditions are ideal for a walk-in visit, and which ones require an appointment.

Learn More