Policies & Forms

Office
Visits Telemedicine
Visits After-Hours
Care Immunization Policy Medication Refills Specialist Referrals Office
Forms Athletics Forms

Well Child Visits

One of the most important services we provide is well child visits, where the staff and physician can collaborate with the patient and family to optimally develop mental, physical and social health. Together we can achieve and maintain physical and emotional well-being of all the patients under our care.

We follow the guidelines from the American Academy of Pediatrics’ Bright Futures.

Detailed schedule and handouts »

Growth
We will discuss weight, height and either head circumference or body mass index. Growth charts will be provided and reviewed.
Development
We will discuss age-appropriate developmental milestones.
Immunizations
We will administer life-saving immunizations according to the recommended CDC schedule. Well child visits must be current in order to update missing vaccines.
Hearing & Vision
We follow the American Academy of Pediatrics Guidelines regarding hearing and vision screening. State-of-the-art hearing and vision tests are routinely administered at age-appropriate visits.
Nutrition
We will discuss age-appropriate nutrition at every well child visit and correlate with the patient’s growth curves.

Behavior
We will discuss age appropriate behavior, such as separation anxiety, changes in sleep habits, and temper tantrums, as well as the use of appropriate discipline techniques.
School-Age Children
We will discuss progress in school and any academic concerns that may arise.
Sports Physicals
Scheduled well child visits also serve as sports/camp physical exams.
Adolescence
We know parenting teens can be challenging and we are here to help. At your teen’s wellness visit, we will review healthy approaches to the transitions they are experiencing. Your doctor will generally spend time talking with you and your teen, then time will be allotted to each patient to review any topics they want to discuss privately. This allows an opportunity for your child to advocate for their own health.

Same-Day Sick Visits

Because we understand children can become ill quickly and unexpectedly, we offer same-day sick appointments. We manage minor injuries, including wound closure and some splinting/casting.

X-ray and lab are available on site for older children age 6 years and above, for younger children we utilize the lab and radiology services at Seattle Children’s Hospital.

Consultations

Some chronic health conditions such as asthma, ADHD, and mental health require regular follow-ups and medication checks with your chosen pediatrician at least every 6-12 months, or more frequently based on a child’s individual situation.

Telemedicine Visits

We offer telemedicine appointments. For many concerns, such as follow up appointments, consults and even some sick visits, we can see your child with a telemedicine visit from the comfort and safety of your own home. We are not able to provide telemedicine well visits or for any patient that is out of the state.

These visits can be scheduled during our normal office hours. We want to provide you with expanded access to your child’s medical home and keep your family out of the emergency room or urgent care.

Making an Appointment

To set up a Telemedicine visit, please call our main number (206) 368-6080 with your child’s name, DOB, and preferred method of contact.

During Office Hours

One of our front office staff will schedule your appointment time.

You will be sent a link to our Telemedicine waiting room. These virtual visits can be performed using a smart phone or computer (with Chrome, Safari or Firefox browsers).

Preparing for Your Child’s Telemedicine Visit

5 Steps to Check in for Your Video Visit

Choose a well lit space. Have extra light such as a flashlight if needed.
The doctor will want to see your child for the visit.
If possible, have your child’s weight and temperature.
Have your preferred pharmacy information handy.
Have all medication your child has been taking.
Write down your main questions.
We are using a secure HIPPA compliant Telemedicine platform and ensuring privacy from our location. Consider any privacy needs in your space.

Remember, if your child’s illness or injury is life-threatening, call 911.

After-Hours Calls

As pediatricians and parents, we know that having 24/7 access to health care advice is very important.

Urgent Questions / Triage Nurse

If you have an urgent concern, always call our office at (206) 368-6080, regardless of the time of day.

We encourage families to call during business hours and utilize our website and symptom checker for after-hours care. If you need to call, you will be connected with a pediatric-trained triage nurse from Triage4Pediatrics. There is a $10 fee per call for this service. Your insurance will not be billed for this fee, and it will be your responsibility.

Non-Urgent Concerns

Questions about mild illnesses and non-urgent concerns can usually wait until the next morning. Please call during office hours for non-urgent medical advice and to schedule appointments.

Monday – Friday: 8:00am – 5:30pm
Saturday: 9:30am – 12:00pm

Our A to Z Resource Guide contains some valuable home-care advice, as well as a symptom checker.

Secure Text Messaging

If you have a non-urgent question, you can send a message to us via our patient portal. Please allow up to three business days for a response.

Urgent Care

If it is determined that your child needs to be seen by a doctor before morning, you may be referred to one of the facilities below. If you’re not sure where to bring your child, consult this guide:

Emergency or Urgent Care »

Seattle Children’s Hospital Emergency Room
24 hours, 7 days a week

Seattle Children’s Hospital Urgent Care Clinics
Urgent Care locations in Bellevue, Everett, Federal Way and Seattle, and virtual urgent care anywhere in Washington 365 days a year, including holidays. Urgent Care provides services to children and teens up to their 21st birthday.

For in-person visits, please make an appointment before you arrive to ensure your child will get care.
Please note this is an estimated time to be seen. Due to high demand, you may have to wait even if you
have reserved a time. Walk-in visits are limited and cannot be guaranteed.

Please schedule online or call (206) 987-2211 for an appointment. Please have the following information available when you call:

Your child’s main symptoms
Any chronic disease or health problem
Your child’s temperature, if he or she is sick
The names and dosages of any medicines your child is taking
Your pharmacy’s phone number
Your questions – it is a good idea to write them down

Immunization Policy

We, the physicians of North Seattle Pediatrics, believe that vaccinating your child is the most important health-promoting intervention we can provide.

We believe in the effectiveness of vaccines to prevent serious illness and to save lives.

We have reviewed current studies and available literature, and we agree with their conclusions that vaccines do not cause autism or other developmental disabilities.

We believe, therefore, that all children and young adults should receive all of the recommended vaccines according to the schedule published by the Centers for Disease Control and the American Academy of Pediatrics. These vaccines and their schedule are the results of many years of scientific study.

Because of the success of vaccines in preventing disease, many people have not seen the diseases we are immunizing against. Sometimes this causes parents to question the necessity of vaccinating their children. However, failure to vaccinate your child puts him/her in danger of serious disease as well as endangering other children and adults he or she encounters.

To keep you informed and to address any concerns you may have, we will provide you with information about each vaccine your child needs. Your child’s doctor will be happy to address any concerns you have about immunizations during his or her well child appointment. Check here to see what vaccines your child might be due for at the next visit.

If you choose to delay or forego vaccinations for your child, we will ask you to sign a vaccination refusal form. This form documents that we have informed you of the risks of delaying or denying immunizations, and that you choose for your child not to receive one or more vaccines, against our recommendations.

Immunization Records

Looking for a copy of your child’s immunizations? From MyKidsChart (the online portal), you can print out a copy of his/her immunizations. MyIR Mobile in partnership with WA State Health Department allows you to review immunization history, get reminders for future immunizations, and even print out your own official records.

If your child needs an immunization, and is not due for a well-child checkup, please call our office at (206) 368-6080 to schedule an appointment.

Immunization Resources

Our A to Z Guide includes an information sheet about each vaccine your child needs, as well as a list of reliable web sites where you can read facts about immunizations and vaccines.

Learn more »

Medication Refills & Specialty Prescriptions

Our goal is to provide the safest and highest quality of care to our patients at all times. One of the ways we do this is to have your child’s regular doctor, who knows your child the best, refill his or her prescription medications. Some medications require periodic adjustments, and your child’s doctor wants to work closely with you to determine when these are necessary.

To better serve our families, we refill prescriptions during office hours only. This allows us to have access to your child’s chart, ensuring proper medical care and follow up.

We require 3 business days (before you run out of the medicine) to process all refill requests. Thank you for your cooperation in this important matter.

Please call your pharmacy during office hours and ask them to submit the refill electronically or to fax us a refill request. Our fax number is 206-368-6088.

ADHD Medication Policy

Stimulants are medicines for attention deficit hyperactivity disorder (ADHD). They are part of a class of medications called controlled substances. Our doctors will send these prescriptions electronically, directly to your pharmacy of choice.

Download our ADHD Medication Policy »

Prescription Renewals

You may call or send a portal message requesting the refill needed. Please include the name of the medication and dose your child takes with your request.

For electronic refills we request 3 business before you run out of the medicine. For mailing prescriptions, we ask that you request the refill at least 5 business days. This allows your primary physician to be involved in the refill. Refill requests go to the primary physician and will not be filled by an on-call physician unless your primary physician is out of the office for over 5 business days.

Contact our office at (206) 368-6080 or use the patient portal to send a request to your primary physician.

Medication Follow-Up Visits

If your child is just starting the medication, a monthly visit will be required until the medication/dosage/timing are optimized and stable.
Once stable on a medication, in-office medication follow up visits will need to be scheduled every 3 months for the first year of treatment. At these visits, as long as there are no changes in medications, your child’s provider will be able to provide you with three months of prescriptions.
When your child has been on a stable dose of medication for a year, in-office medication checks will be needed every 6 months.
Due to insurance reimbursement rules, we are no longer able to combine medication follow up visits with well visits.

Specialist Referrals

Most pediatric concerns can be diagnosed and treated at our office. However, should your child need a consultation from the specialist, our physicians will discuss the proposed referral with you and then initiate the process.

Frequently Asked Questions

When is a referral required for my child to see a specialist?

It is always a good idea to contact our office before taking your child for specialty care. We can make your doctor aware of your child’s medical condition and give you recommendations so your child receives the best possible care. If you have a managed care policy, the charges will not be covered without a referral from your primary care physician. Many specialists also require a letter and chart notes from your PCP prior to scheduling even if your insurance does not require one.

What if I see a specialist and forget to request a referral first?

Some insurance policies will allow for retroactive referrals but some will not. You may be responsible for the charges. Call our business office as soon as possible after your child is seen.

What should I do if my doctor refers my child to a clinic at Seattle Children’s Hospital?

Our office will need to submit an appointment request to the clinic before they will schedule your child. Please allow 3-4 business days for this process to be completed before you call to schedule. If your doctor did not provide you with the direct number to call, you can contact the main hospital operator at 206-987-2000 and they will connect you with the specialty clinic.

What if I am seen at the Children’s After Hours Clinic or an Urgent Care Center?

If your insurance policy requires referrals, please contact our office on the next business day.

What if my doctor recommends speech, physical or occupational therapy services for my child?

You should first check with your insurance company to see what services are covered by your plan. Some policies do not cover ‘neurodevelopmental services’, or will only cover them up to a certain age or for a certain type of diagnosis. If services are covered, you will need to go to a contracted provider and have a prescription from your doctor. Our office can provide you with a list of resources in your area.

What if my child requires a mental health or behavioral consultation?

Mental health and behavioral consults are often handled differently by the insurance companies. Please refer to the special phone number on the back of your insurance card to access these benefits. In many cases, this type of referral must be initiated by the parent/guardian as opposed to the doctor’s office.

Office Forms

New Patient Resources

Prior to calling to register your child as a new patient, please contact your insurance company to make sure we are in network. Additionally, before registering your child we will need their previous medical records sent over to our office. You can contact your previous provider to fax or mail these to our office at 206-368-6088 or you can bring them in by hand. For newborns, we will request records directly from the hospital.

In preparation for your first visit we have bundled all forms to be completed in the New Patient Registration Packet. These forms can simply be printed as they exist and filled out by hand. However, they would then need to be faxed, or mailed to us.

These forms can be filled out electronically provided you either have the free Acrobat Reader software, or have a web browser with the appropriate PDF plug-in enabled. Once the form is filled out, you should save it on your computer in a location you will remember. Then log on to the NSP Patient Portal (My Kids Chart), which will be set up for you when you register, and send a message with the saved form(s) attached.

If you are unable to fill these out prior to your first visit, we will have a printed copy for you to complete. DO NOT send completed forms via email.
New Patient Registration PacketCall clinic first to register, then download all new patient forms conveniently bundled into one PDF.
Patient Demographics
Patient History
Family History
Consent to Treat Consent for treatment, patient portal registration, and care giver authorization
Policies and Procedures
Billing & InsuranceLearn about our accepted insurance plans and our billing policies.
Medical Records ReleaseAuthorization to release protected health information to North Seattle Pediatrics

CHADIS

CHADIS is an interactive online screening tool designed to provide your children with the best care possible.
About CHADIS
Login to CHADISCHADIS forms are accessed from our patient portal.
How to Invite a TeacherStep by step instructions on how to invite your child's teacher to complete a Teacher Vanderbilt screening.

Medical Records

Complete these forms to permit information to be shared between doctors, or between teachers and doctors.
Medical records release to usAuthorization to release protected health information to North Seattle Pediatrics
Medical records release from usAuthorization to release protected health information from North Seattle Pediatrics to teacher, doctor, or other party
13 Years and Older Release Form When a patient turns 13 years old in the state of Washington, by law, the record for that patient automatically becomes private. After the patient is 13 years old, he or she may grant permission to a parent or guardian to have access to the chart by completing and signing this release form. This permission can be revoked at any time at the request of the patient or at the discretion of the physician.
My Kids ChartPatient Portal registration
My Kids Chart Patient Portal registration for 13 years and up
18 Year packetAs a legal adult, new paperwork must be completed and signed by the patient.

ADHD

These scales are used by healthcare professionals to help diagnose ADHD in children and young adults.
Vanderbilt Parent Assessment
Vanderbilt Parent Follow-Up
Vanderbilt Teacher Assessment
Vanderbilt Teacher Follow-Up
Adult ADHD Self-Report Scale
ADHD Medication Policy

Development

9 Month ASQPlease complete this questionnaire just prior to the 9 month checkup.
Well Child Visit Handouts

Screenings

School Athletics Forms

Is your middle school or high school student interested in trying out for a school team sport?

To prevent any delays in participating, your child needs to have a current well child exam at our office. Most schools require an athletic clearance or physical form to be completed and signed by our doctors every year. We can only complete this form if you child has had a well child/sports physical exam within the past two years.

Please allow 3-4 business days for our staff to complete the form. Also, prior to sending the form to our office, please complete the health history section or fill out our health history questionnaire.

Any questions about the forms? Please contact your school’s athletic department.

Our fax: 206-368-6088. Or the forms can be scanned and sent to us via the MyKidsChart patient portal.

School Athletics Depts

Here are links to the athletic departments for our nearby public school districts and private schools.
Health History QuestionnairePrior to sending the school form to our office, please fill out our health history questionnaire.
Seattle Schools
Edmonds Schools
Northshore Schools
Shoreline Schools
Everett Schools
Mukilteo Schools
Bishop BlanchetPrivate school
King’s Jr/Sr HighPrivate school

Policies & Forms

Policies & Forms

Well Child Visits

Same-Day Sick Visits

Consultations

Telemedicine Visits

Making an Appointment

Preparing for Your Child’s Telemedicine Visit

After-Hours Calls

Urgent Questions / Triage Nurse

Non-Urgent Concerns

Secure Text Messaging

Urgent Care

Immunization Policy

Immunization Records

Immunization Resources

Medication Refills & Specialty Prescriptions

ADHD Medication Policy

Prescription Renewals

Medication Follow-Up Visits

Specialist Referrals

Frequently Asked Questions

Office Forms

New Patient Resources

CHADIS

Medical Records

ADHD

Development

Screenings

School Athletics Forms

School Athletics Depts

North Seattle Pediatrics

Office Hours

After-hours Care