Patient Forms

We are excited that you have chosen Dr. Kumar for Kids for your child’s medical care. Your comfort and convenience are our priority, and we strive to make every visit to our office a positive experience. To help you get acquainted with our office and first visit procedures, we have included helpful information on this page.

How to get the most out of your child’s first visit

Please come in few minutes early for the appointment. Be ready to provide your child’s family, social and health history.  Make a list of medication your child is taking (or bring in the bottles). Write it down if that helps.

Bring your child immunization record, past medical records and insurance card.

Patient Forms

Please download our patient forms. All forms are in PDF format.

In order to view or print these forms you will need Adobe Acrobat Reader installed. Click here to download it.

Payment Responsibility

While we accept most insurance plans offered in the area, we may not be a participating provider for some plans. We urge you to verify the insurance coverage before visiting us.

Based on your insurance plan and medical benefit, you could be responsible for charges beyond copayment paid at the time of visit. These may include your deductibles, co-insurance or services not included in your plan coverage. You will be asked to authorize us to charge your credit card of choice at the time of your visit. Your card will charged only after your claim is processed by your insurance company. We also send an email notification 5 days before your credit card is charged. You will receive receipts via email detailing the amount charged.

If you haven’t met your deductible, don’t have insurance or don’t have a plan we currently accept, we require you to pay for the services at the time of visit.