Before Your Visit
How to prepare, and our practice policies
We've Moved!
Century-Airport Pediatrics has moved to Our Lady of Victory Human Services (OLV), 790 Ridge Road, 1st Floor, Lackawanna, NY 14218.
How To Prepare
Before your scheduled visit
Appointments
Please arrive 10 minutes prior to your scheduled appointment. Late appointments may be asked to reschedule.
Pharmacy
COVID / Flu Testing
Call Reminders
Insurance Questionnaires
Telemed Calls
New Patient Information
School / Health Forms
One policy, one place
Forms can be completed if the LAST WELL CHILD VISIT is within 1 year. Please allow up to 2 weeks for completion. Please indicate if needed sooner and we will do our best to accommodate you.
Please put CHILD’S NAME & DATE OF BIRTH on all forms and be prepared to sign other forms for us to have the ability to send information (fax). When applicable, provide a self-addressed stamped envelope and complete PARENT SECTION first, otherwise completed forms will be sent to the Patient Portal or available for pick-up once completed.
Practice Policies
Century-Airport Pediatrics practice policies
For more information, or to schedule an appointment, call us at (716) 893-7337.
Failed / Missed Appointment Policy
One “Failed” appointment (without 12-hour notification) will result in a $35 fee. Future well visits may be delayed. C-AP considers weather and environmental issues, but other reasons for a missed or failed appointment outside of the time frame, will require documentation.
Century-Airport Pediatrics focuses on patient care for children including patient follow-up and appointment compliance. Non-compliance, missed, failed or no show appointments may result in dismissal from our practice. Revised 1/2021
Co-Pay Policy
Outstanding Balances
Preferred Caregiver
Custodial Parent / Office Visit Policy
The staff of Century-Airport Pediatrics assumes the “Mother” and “Father” of the patient (as listed on our demographic sheet, which is completed & reviewed by a parent at each visit), are the custodial guardians of the patient. We are under strict governmental regulation to not release information to anyone who is not a custodial parent (or has not signed our Parental Consent sheet). Parents must inform us, in writing, of any changes in guardianship or custody, and supply proper legal documentation.
Should it ever be necessary for your child to be scheduled for an appointment when you cannot be present at the visit, we must have your written permission stating you have given permission to “whomever” to bring the child in, as well as to make any medical decisions necessary (including vaccinations). Your note must be signed and the signature must match the signature we have on our child’s HIPAA form. Your note can be date specific (for the day’s visit only), or you can complete the “Third Party Release” form which is good for one year from the date signed. These forms must be updated annually.
Children may be seen without a parent, at the discretion of the provider from their 14th to their 18th birthday (this scenario is NOT encouraged, and written parental consent for shots is required). Patients as of their 18th birthday may be seen and receive immunizations without parental consent (but again this scenario is NOT encouraged).