MWCP | My Whole Child Pediatrics

Forms and Policies

Our office provides comprehensive medical care for children from newborns to 21 years. The visits to the office are by appointment only. If you are late for your appointment and have not called and made arrangements, you may have to be rescheduled. We try to maintain your appointment schedule as well. However, sometimes emergencies and unpredictable circumstances during another patient’s visit might delay your appointment. Same day cancellations of appointments are subject to a cancellation fee. It is extremely important that you bring all of your child’s health and insurance information to the visit to prevent any inconvenience and delay in attendance to your child. If the child is sick and needs to be seen, we will try to accommodate the child that same day if the office schedule permits.

Don’t forget to call our office to verify and ensure that we participate with your insurance plan as participation may have changed. If you are required to have a primary care physician by your insurance plan, Dr. Naveen Mehrotra must be listed as the primary care physician on your card to cover the visit or we will not be able to see your child in the office. It is your responsibility to have the proper insurance information to be seen. If your plan requires a copayment, coinsurance, or deductible which is due at the time of the visit, it must be taken care of at the time of the visit.

If you have recently moved into the area or are looking for a new pediatrician, please call the office and schedule an appointment for a visit. Prior to the visit, please contact your previous pediatrician and ask for your child’s records to be transferred to Dr. Mehrotra’s office. The Release of Records form that needs to be given to the previous pediatrician is available on this site for your convenience. Any fees associated with the file/transfer of the file, is your responsibility and should be handled directly with their office.

Our fees for various services are as follows and are payable by cash,check, or credit cards:

All charges not covered by the insurance company are the responsibility of the patient. Policies are subject to change without notice. Please do check with the office for updated information/changes in policies.

Cancellation of appointment:

There is a $25 charge for same day cancellations of appointments.

Release of records:

There is a $20 charge for the Release of records (Includes copy and mailing charges)

Immunization records :

There is a $2 charge for a copy of the immunization records after your visit. (Please ensure that you get your immunization card completed at the time of the visit)

Ear Piercing:

Our office offers ear piercing at $100 payable at the time of the service (includes ear studs). An appointment needs to be made for this separately.

Form completion:

There is a $5 charge to complete all school related, camp, work, and other forms.

Travel vaccines and counseling

Travel vaccinations may not be covered by the insurance company. Please check this before you get your vaccinations.

If you have any questions, feel free to reach us at:

Edison Office	Piscataway office	North Brunswick office	Elizabeth office	New Brunswick office	Jersey City office	Plainsboro office	Old Bridge Office	Union City office
FAX: (732)-738-9585 PH : (732)-738-1341	FAX: (732)-819-8801 PH : (732)-819-8800	FAX: (732)-398-9030 PH : (732)-398-0900	FAX: (908)-659-1001 PH : (908)-289-2239	FAX: (732)-545-9877 PH : (732)-545-9878	FAX: (201)-222-2099 PH : (201)-963-2320	FAX: PH : (609)-750-1521	FAX: PH : (732)-679-8200	FAX: PH : (201)-865-6750

For your convenience here are common forms that can be downloaded and completed prior to your visit to expedite your visit.
Typically form completion will take 3-5 business days so please plan accordingly. Same day forms will not be accommodated. Child must have had an active physical in the last one year for form completion.

Patient Registration form	Download PDF FORM
Patient Consent form	Download PDF FORM
Assignment of Insurance Benefits	Download PDF FORM
Release Request Form	Download PDF FORM
HIPPA	Download PDF FORM
Authorization for a Secondary caretaker	Download PDF FORM

Forms and policies