Office Policies and Procedures

Vaccination Policy

California Kids Pediatrics follows the current vaccine schedule recommended by the American Academy of Pediatrics. We will not require you to vaccinate, however we will strongly encourage vaccinations and will discuss it at every wellness visit.

School/Sports Form

There will be a $25.00 charge per form. School and sports forms are subject to be filled out based on the patient's last physical/well child check.


We participate in most PPO insurance plans and TIMPA HMO Medical Group in order to make our practice accessible to all families in the community. Please call your insurance company to make sure we are an in-network provider for your plan.

Patient Privacy Policy

Under the Health Insurance Portability & Accountability Act of 1998 (“HIPAA”), I have certain rights to privacy regarding my protected health information. I understand that this information can and will be used to:

  • Conduct, plan and direct my treatment and follow up among the multiple healthcare providers who may be involved in the treatment directly and indirectly.
  • Obtain payment from third-party payers.
  • Conduct normal healthcare operations such as quality assessments and physician certifications.

I acknowledge that I may request your Notice of Privacy Practices containing a more complete description of the uses and disclosure of my health information. I understand that this organization has the right to change its Notice of Privacy Practices from time to time and that I may contact this organization at any time to obtain a current copy of the notice of Privacy Practices.

I understand that I may request in writing that you restrict how my private information is used or disclosed to carry out treatment, payment or other health care operations. I also understand you are not required to agree to my requested restrictions, but if you do agree then you are bound to abide by such restrictions.

Medical Records Request

If you wish to obtain a copy of your medical records you must complete the authorization to release records form, which can be obtained by calling the office. Please note that there is a $25.00 fee for each request. All outstanding balances must be paid before records are released.

Cancellation, Late and No-Show Policy

We appreciate that most patients make their appointments well in advance and show up on time, but not infrequently, families arrive very late, or do not show up at all for an appointment without prior notice. Lateness makes it difficult for other patients who have arrived on time to be seen as close to appointment time as possible. Not showing up wastes the doctor’s time and uses up an appointment time that another patient may have desired. To alleviate this problem, we have a policy in which we ask that any patient who cannot make it to the appointment cancel at least 24 hours prior to the scheduled time. If you are running more than 15 minutes late for a wellness check or 10 minutes late for a sick visit we may reschedule. There will be a $75 charge per patient who does not show up for an appointment without 24 hours prior cancellation. We understand that there are always extenuating circumstances, so we apply this policy judiciously.

Financial Information and Authorization Policy

Any deductible, co-payment, co-insurance or balance is due at the time of visit before you see the Doctor or Nurse Practitioner. Insurance health plans create a network that certain providers are selected to be a part of. We may accept the insurance company; however, we might not be contracted with the type of plan you have. It is the patient’s responsibility to confirm if we are IN NETWORK with your health plan. If this office is able to accept your insurance, the patient is still fully responsible for services rendered. Your insurance may not cover the services or may only partially cover them. The office can make no guarantee of actual payment by your insurance company. Even though an insurance claim has been filed, you will still receive a statement each month from our biller who will provide you with the outstanding balance due on the account, since you, not the insurance company, is ultimately responsible for payment on the account. It is the parents, guardian or patient’s responsibility to provide the office with any new or updated information when it comes to new insurance, change of address, phone numbers or credit card information. Our office will be keeping credit card information on file. The office will continue to mail out and email statements. You will have the option to self pay online, pay in person, mail in a check or pay over the phone by contacting the office. I authorize the release of any medical information to my insurance carrier that is necessary for processing of claims. I authorize payment of medical benefits directly from my insurance carrier to California Kids Pediatrics, Leila Bozorgnia, M.D., for services provided.

**Please note any past due balance from Dr Berman’s previous office will be collected upon arrival at the new office.