Edgewood Center Pediatrics, P.C.
8896 Commerce Rd, Suite 5
Commerce Township, MI 48382
Ph - 248-360-9241
Fax - 248-360-0830

Policy for Divorced or Separated Parents

Edgewood Center Pediatrics is dedicated to providing the best quality care to your child(ren). The following policy has been established to avoid any misunderstandings.
  • A divorce decree is an agreement between the court and the parents/guardians involved. Any court orders denying medical access to a parent/guardian must be on file in the patient's chart. Edgewood Center Pediatrics will not be involved in any disputes between parents or other responsible parties in office or any other form of communication.
  • Please make decisions regarding appointments, vaccinations and/or any other office procedures PRIOR to the scheduled appointment
  • If there is NOT a court order on file with our office, either parent or legal guardian can schedule an appointment for their child, be present for the visit and/or obtain a copy of the visit summary. Either parent or legal guardian can also sign a “Consent to Treat” form that authorizes named individuals (like grandparents, nannies etc.) to bring your child to our practice, be present during the visit and consent to any treatment during the visit. We will not be involved in any disputes regarding named individuals on the consent forms unless instructed by the court documents.
  • It is our policy; the person who brings the child in is responsible for payment of any balance due at the time the service is rendered including copay, deductible, and coinsurance. Any divorce agreements are handled by the involved parties, not by our office. We will gladly furnish you with necessary statements for reimbursements.
  • It is both parents’ responsibility to communicate with each other about the patients’ care, office visit dates and any other pertinent information relevant to the patient. It is not the provider’s responsibility to communicate the information regarding the patient’s visit to each custodial parent separately. Our providers are not able to call the non-attending parent following visits. Additionally, we will not call a parent to notify of an appointment scheduled by the other or get in the middle of disagreements with parents calling to cancel appointments scheduled by the other parent. Cancelations of each other’s scheduled appointments will result in dismissal from the practice.
  • We reserve the right to discharge the family from the practice due to non-compliant behavior or failure to follow this policy. Any abusive behavior or language towards staff or between parents/patients will result in immediate discharge from the practice!

I, the undersigned, understand & agree if applicable to the above stated terms of this policy.