Melissa Thingvoll, MD – Appointment

Scheduling an Appointment – New Patients

In order to schedule an appointment, the following new patient forms must be received by our office.  You will also need to have the physician referral and teacher packet sent to our office (see below) prior to scheduling your appointment.

            □New Patient Intake Form

            □Financial Policy Consent Form

            □Vanderbilt Assessment Scale – Parent Informant

These three forms can be downloaded as a single packet here

New Patient Intake Packet

You will also need to have a referral form filled out by your pediatrician and a questionnaire filled out by your child’s teacher prior to scheduling your appointment.

Physician Referral Form

Teacher Evaluation Form

Also, please provide us with any previously done developmental or educational testing reports that may help in your child’s evaluation.

It is important for the child to be accompanied to the appointment by a parent or guardian with knowledge of the child’s medical, behavioral, and developmental history.

Once our office receives and reviews these forms, we will call you to schedule an appointment. If you have not heard from us within 7 business days after sending your new patient intake paperwork, please contact our office. New patient evaluations are typically scheduled for 90 minutes and follow-up appointments are typically scheduled for 30 minutes.

Due to scope and complexity, some referrals are not appropriate for this practice. If this is the case, our office will contact the referring provider and suggest alternative sources of care.

At the time of your appointment, please bring your insurance card. You will also be provided with a copy of our Notice of Privacy Practice (HIPAA) and asked to sign an acknowledgement of receipt of this notice.

Credit Card Policy

We require a valid credit card to be on file in order to schedule an appointment. This credit card will be used to charge “no show” and “late cancellation” fees (see Financial Policy Consent Form) when appropriate. Credit card information will be stored in a PCI (Payment Card Industry Security Standard) compliant database through TransFirst Health. Please note that Medicaid patients will not be required to have a credit card on file.

Cancellation Policy, Missed Appointments and Late Arrivals

We kindly request notification of at least 48 business hours to cancel and reschedule an appointment. Please refer to our Financial Policy Consent Form for fees associated with late cancellations and missed appointments.

If you arrive more than 10 minutes later than the scheduled time for your appointment, your appointment may be rescheduled and you will be charged the fee for a missed appointment according to the Financial Policy Consent Form.