Forms and Records Fees

Our office charges for the following forms, requested after your visit to our office for your child’s well visit.

  • Shot Records – $5
  • Physical Forms – $5
  • Sports Forms – $5
  • Camp Forms – $5
  • EED – $10

Shot Record and Physical Forms will be given automatically at no charge on the day of your child’s well visit, along with any camp/physical forms that you bring to us. These charges will only apply when you need forms before your child is due for a well visit again. The only form charged outside your well visit will be the $10 EED form. Our goal is to trim down the turn- around time for these requests, as our back-to-school season approaches.

Our Vaccine Policy

Dedicated to Providing The Best Care That We Can For Our Patients

  • We firmly believe in the effectiveness of vaccines to prevent serious illness and to save lives.
  • We firmly believe in the safety of our vaccines.
  • We firmly believe that all children and young adults should receive all of the recommended vaccines according to the schedule published by the CDC and the AAP.
  • We firmly believe, based on all available literature, evidence and current studies, that vaccines do not cause autism, other developmental disabilities or harm.
  • We firmly believe that vaccinating children and young adults may be the single most important intervention we perform as healthcare providers, and that you can perform as parents/caregivers.

We at Coastal Pediatrics are dedicated to providing the best care that we can for our patients. To do so effectively, we feel that we must enter into a partnership based on mutual trust with the parents of our patients so that together we can achieve this goal.

We are obligated to deliver the best and safest healthcare possible for our patients and our community. We feel professionally uncomfortable caring for children who will not receive a minimal set of vaccinations. We want to emphasize the importance of vaccinating your child. We recognize that the choice may be a very emotional one for some parents. Should you have doubts, please discuss these with your healthcare provider in advance of your visit. In some cases, we may alter the schedule to accommodate parental concerns or reservations. Please be advised, however, that delaying or “breaking up the vaccines” to give one or two at a time over two or more visits goes against expert recommendations, and can put your child at risk for serious illness (or even death) and goes against our medical advice as providers at Coastal Pediatrics. Such additional visits may require additional co-pays on your part.

We strongly recommend the vaccine schedule published by the CDC. If your child is currently underimmunized, for whatever reason, we REQUIRE they receive at least two vaccines per month until they are caught up to the recommended schedule, with the only exceptions being Flu and HPV. Failure to comply will result in discharge from the practice.

We feel that by not vaccinating your child(ren), you do not trust our values, philosophies, or the science involved in providing safe and effective care. Although we respect your decision not to immunize your child(ren), we do not agree and feel you are placing your child(ren) and others at great risk. If you are unwilling to obtain the required vaccines for your child(ren) despite all of our efforts, we will, with great reluctance, send you a letter discharging your child(ren) from our care and ask you to find another healthcare provider who share your views. We do not keep a list of such providers, nor would we recommend any such physician. It is our hope that no patient is discharged from our practice due to vaccine refusal.

Thank you for your time in reading this policy, and please feel free to discuss any questions or concerns you may have about vaccines with any one of us.


The Staff of Coastal Pediatrics

Patient Forms

Forms can be completed online through the patient portal or you can print them from our website and bring them with you to your appointment.

Insurance & Fees

We will ask you to verify your current insurance coverage at every visit. If your insurance coverage changes, please have your new insurance cards available at that time. Before each vaccination visit, find out if your insurance plan covers your child’s immunizations. Be sure to notify your employer/ insurance company about any new additions to your family! For questions related to billing and insurance, please contact us by email or call us at 912-353-7744.