At the time of your appointment,
please bring:
  • Photo ID
  • Insurance cards
  • New Patient Form (if applicable)
  • All diagnostic tests
    (MRI, X-rays, CT scan)
  • List of current medications
  • Co-payments

Scheduling

DFW Pediatric Neurology is currently accepting
new patients and has immediate openings.

 

Contact us now to secure an appointment
817-416-8887

contactus@dfwpn.com

Insurance

Please call our office at 817-416-8887 for the most up-to-date insurance information.
We accept the following insurance:

 

  • Accountable PPO
  • Aetna HMO/PPO
  • BCBS - PPO/POS (Dallas)
  • BCBS - PPO/POS (Rural)
  • Cigna HMO\PPO
  • First Health/Coventry PPO-Dir Payors
  • First Health/Coventry PPO-Ntwk Lease
  • Payors First Health/Coventry Work Comp
  • Galaxy PPO
  • Healthsmart GEPO
  • Healthsmart POS
  • Healthsmart PPO
  • Independent Medical Systems – PPO
  • PlanVista PPO (NPPN)
  • Principal Edge Network PPO
  • Texas True Choice PPO Star
  • United Healthcare Non-Options
  • United Healthcare Options PPO
  • Self Pay

Policies

Click on the policies below for more information.

Cancellations
If you have a scheduled appointment time and need to reschedule or cancel, please notify our office at least 24 hours prior to your appointment. We will gladly reschedule a more convenient appointment time for you. If you do not show up for your scheduled appointment, you will be charged a $25 no-show fee. Three no-shows may result in dismissal from the practice.
Emergencies
All emergencies are seen in a timely fashion, based upon the urgency of your problem. In a true emergency, it is best to go to the emergency room at your nearest hospital. The emergency room staff will contact us or the physician on call. You have the right to request direct care from one of our physicians when in the emergency room.
Confidentiality
We understand your medical information is personal, and we are committed to protecting this information. We will not disclose information regarding your condition to anyone without your written, signed consent. We will only use your health information for treatment, to obtain payment for services provided, or to provide employees with information about you relevant to your care. We will disclose information in special circumstances, such as when required by law, to prevent a serious threat to your health and safety.
Medication Prescription Policy
DFW Pediatric Neurology is happy to help you with your neurological needs. That includes supplying needed medication for our patients. We do have certain guidelines for refilling your medications prescribed by our physician. If you need a refill on your medication, we ask that you call your pharmacy at least three days prior to your refill and tell them which medication that you need refilled. They in turn will call us with all of the information we need to be able to refill the medicine. (If you call us first, we will ask you to call the pharmacy.) We do not refill medication after business hours or on the weekends. Our staff does not have access to your medical records after business hours. Please make sure that you contact your pharmacy before you run out of medication to allow time for the refill to be processed. All refills are authorized by the physician, so we must have ample time to contact the physician for authorization.
Any calls for medication received after 3:00 P.M. will not be addressed until the following business day. If you call the answering service after hours for a medication refill, there will be a $25 fee for the non-emergency call and the request will not be addressed until the following business day.
HEALTH FORM POLICY
DFW Pediatric Neurology charges $20.00 for forms and/or letters completed or certified by our physician. Before submitting a form to your physician, please have your portion completed. Blank forms will not be accepted. We will not complete or certify a form if parents have not completed their portions of the form upon submission. A three business day turnaround time is required for completion of forms. Requests for letters require a week turnaround time. Every effort will be made to complete forms as quickly as possible.

Forms and letters are completed for accounts that are in good standing. Delinquent accounts must be brought up to date. Forms and letters must be paid for before they are released. Parents are responsible for all charges associated with a Health Form/Letter completion. Insurance companies do not reimburse for the completion, therefore we do not bill them. This is a self-pay service.

Due to HIPAA regulations, forms will only be released to parents. Federal law prohibits doctors' offices from faxing or mailing medical information to non-medical facilities. Forms must be picked up at the office by a parent or mailed to the home address on file. We cannot fax or e-mail a form to a school, camp, or sports organization. We cannot be responsible for delays or losses in the mail or fax.

Connor’s, Vanderbilt, FMLA, Home Bound, and medication for school and camp, among others will require a $20.00 charge. OHI and seizure plans are forms that we do NOT charge for. Patients not seen within a year will need to be seen by the physician before completion of any form.
MEDICAL RECORDS RELEASE POLICY
To maintain patient confidentiality and assure compliance with federal and state privacy laws, health information may not be released without a patient’s written authorization (except as permitted by law). The information below describes the process of requesting medical records that you may have at DFW Pediatric Neurology. The steps involved depend on what records you want provided and/or to whom you want your records provided. Signed authorization forms must be submitted in person, by fax, or via mail.

IN PERSON
BY FAX
BY MAIL
Drop off the signed form at the front
office of DFW Pediatric Neurology.
817-416-8878

DFW Pediatric Neurology
Attn: Medical Records
1400 West Northwest Hwy #280
Grapevine, TX 76051
Medical records to an outside Provider or Facility
  • Signed and completed authorization form is required
  • No fees charged to process request
  • Up to 15 calendar days to process request
Medical records for personal use
  • Signed and completed authorization form is required
  • There will be a $25.00 fee for the first 25 pages and an additional charge of $0.15 per page copied
  • All mailed records are sent via certified mail and carry an additional $4.00 fee
  • Records are sent by certified mail unless the patient specifies that they want to pick them up. If patient chooses to pick up records, mailed fee does not apply
  • After we receive your completed authorization form, you will be notified of the total cost to prepare a copy of your records. Payment is accepted via check or money order if mailed in. If picking up records, a credit card or cash may be used
  • You request will be processed upon receipt of payment
  • Up to 15 calendar days to process request