title(Forms & Policies) TLC Pediatrics of Amarillo, PA is an independent, self-owned and operated pediatric group. On this page, you'll find information about our general office policies as well as links to some of the forms that you can print out and fill out before your appointment to save time.



To expedite the registration process and for your convenience several forms are made available in PDF format for printing and completion. You can download (using the free Adobe Reader software) and print out. Filling out these forms prior to your office visit can save you time. Please either print the blank forms and fill them out by hand, or simply fill out the forms electronically while online and then print your completed forms (clicking on the editable areas of the form will allow you to fill in your information).
If you are unable to open the for please click here to get Adobe Reader: Get Adobe Reader

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Billing Policies

We LOVE delivering pediatric care and enjoy the personal relationships we have with our patients and families. We must however charge for these services and expect reasonably prompt payment. That way, we can continue to “be there”, whenever you need us. Below is a list of our billing policies that will help us continue to deliver the highest quality medical care that you deserve:
  • Copayments, coinsurances, deductibles, and any charges for non-insurance covered services must be paid at the time of service.

  • You may charge any balance more than $10 to your credit card (MasterCard or Visa). We encourage families to authorize TLC Pediatrics of Amarillo to charge a credit card for balances that appear on their children’s accounts. Credit card authorization forms are available by clicking here. Simply print the form out, fill in your information and mail it, fax it, or bring it with you to your next appointment.

  • Let us know if your family is under significant financial hardship. Payment plans can be arranged if necessary. We want to be sure that your family receives the care you need and deserve.

  • We must have updated confirmation of your insurance and identifying information at every visit. It is your responsibility to let us know of any changes in insurance data, addresses, telephone numbers, etc. and to assure your insurance policy registered with TLC Pediatrics of Amarillo remains updated and active.

  • We will bill the insurance company you designate for the services we provide. If we do not receive payment from your insurance company within 60 days, the balance transfers to your responsibility. You will be notified about any unpaid amounts.

  • If balances not covered by insurance remain unpaid by you after 60 days notification, we may need to reschedule routine checkup appointments.

  • Bounced checks: If your check does not clear your bank on a second submission (we automatically resubmit), you will be billed an additional fee of $35.

  • Repeated Bounced Checks: TLC Pediatrics of Amarillo is unable to accept checks from families if two checks are returned to us without payment. Future payments will need to be made using cash or credit card.

  • Anyone accompanying a patient/child is responsible for balances due at the time of service.
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Phone Calls

We want you to call and we welcome your questions and are here to help you in your important task of raising a happy healthy child. We try to make ourselves as available as possible by opening the office at 8:30am each day and returning your telephone calls throughout the day. During regular clinic hours there is a nurse available by phone to help you with your questions and concerns.

Our nurses have your child's medical record available for documentation as well as accurate information on his/her medical history. They are best able to make recommendations in keeping with the medical advice of your child's physician. They have been instructed in specific information to give about common pediatric illnesses and will consult with a physician prior to giving advice if there is an unusual problem. We have found it difficult for physicians to receive telephone calls and maintain an appointment schedule without creating long waits for patients in the office. Some problems cannot be evaluated over the telephone and you will be instructed to schedule an appointment. A nurse will return your call within 1 or 2 hours--usually much sooner. PLEASE LET THE RECEPTIONIST KNOW RIGHT AWAY IF YOUR CALL IS AN EMERGENCY.

It is preferred that you call early in the day if possible, to give us time to return your call. Please try to leave your phone line open if you are waiting for a call back (ESPECIALLY for after hours calls). If your call involves a non-urgent issue, particularly one that may require more lengthy discussion, please provide an alternate number to return your call later in the day. If you will be changing location or telephone availability within a few hours of calling us, please let us know.

Urgent/Emergency Calls During Office Hours

If your child needs emergency attention at any time, dial 911 immediately to reach Emergency Medical Services. If possible, we urge that you phone 806-353-7900 before coming to the office to ensure immediate attention upon your arrival.

Emergency After Hours & Weekends Calls

You may call our office after normal working hours by calling our main number 806-353-7900. The call will be answered by our answering service. TLC Pediatric of Amarillo shares medical coverage with Panhandle Pediatrics. Panhandle Pediatrics may charge callers a fee of $15.00 for each call placed after hours and/or on weekend. TLC Pediatric of Amarillo does not charge any fees for calls after hours and/or weekends. While we have no control over Panhandle Pediatrics office policies, we strongly suggest that you limit your call to urgent problems, serious concerns and emergencies. To avoid such a cost, we recommend that calls requesting medical advice be made when our office is open.

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It is Our Policy that any child who needs to be seen for an acute illness or injury will be offered an appointment for that day. In the event that you need to change, or cannot keep your appointment, please notify us as early as possible (preferably at least 24 hours prior to the appointment time) so that we can offer your appointment to another patient. Appointments that are canceled with less than one-hour notice will be counted as a missed appointment. We reserve the right to dismiss a patient (and the family) from the practice if there have been three or more missed appointments.

New patients and children scheduled for well visit or physicals are asked to arrive 15 minutes prior to their appointment time to fill out patient information and/or medical forms. Please bring your insurance cards and/or information with you, as we will need to make copies for your file. Also, note that we need to update this information yearly (as well whenever your address, phone number, or insurance information changes) in order to have a valid authorization to bill your insurance.

If you have a question, we encourage you to call during our regular office hours. Our experienced nurses are trained to help you. If you need to speak with your doctor, your call will be returned between patients, during lunch or after 5:00 p.m. Our policy is to have our patients speak to our triage nurse when calling for an appointment for an illness. This is so that we can provide you with timely advice and care. Except for emergencies (asthma attacks, lacerations, etc.), please do not bring your child to the office to be examined if he or she does not have an appointment. We can improve diagnostic accuracy and minimize waiting room delays for both you and other patients if you will be courteous enough to call ahead for appointments.

Initial physical examinations are often lengthy visits, because we need time to get to know each other. It is helpful to have all medical and immunization records sent to us PRIOR to the visit so these can be reviewed beforehand.

Well Child Visits (Check-ups)

The newborn visit should be scheduled at a few days to two weeks of age. Subsequent well visits will occur at  two, four, and six, nine, twelve, fifteen, eighteen, twenty four months, and then annually starting at age three years. These visits provide an assessment of all aspects of your child’s health, growth, development and behavior, and give you the opportunity to ask questions you have. We will discuss what to expect over the next phase of your child’s life. If there is not enough time during the checkup visit to discuss all concerns, or if there are items that would benefit from further discussion. Click here to view the American Academy of Pediatrics recommended check-up schedule.

Rescheduled Appointments

We recommend and greatly appreciate that you call the office 48 hours in advance to make or change an appointment. This will give another child the opportunity to use your original appointment time. If you are running late or are unable to make an appointment, please let us know as soon as possible.

Family Appointments

Please do not ask the doctor to "just take a quick look" at another child "as long as we are here." "Quick Peeks" lead to diagnostic inaccuracies and an additional fee, which your insurance will not cover.


We always want to assist ill children and accommodate families, but well limit walk-ins visit in order to minimize the waiting time, and not inconvenience patients with previously scheduled appointments. Please call us first to schedule an appointment in the event that your child needs to be seen. We do our best to see walk-in urgent patients and extra children brought in to be seen who do not have appointments during regular office hours (though at times that is difficult and can delay other families).


If you need to cancel or reschedule an appointment, particularly a well visit or consultation, please do so at least 24 hours in advance. A significant amount of time is allotted for these appointments and we would like to offer this time to other patients if you are unable to keep your appointment. Repeated routine appointments missed or cancelled with less than 24 hours notice will cause a dismissal form.

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For existing illnesses that require a periodic medication refill, please call during office hours to refill your child's medication, and have your prescription and pharmacy telephone numbers ready. Please do not call for routine medication refills after hours.

For new prescriptions, we ask that you make an appointment to see one of our doctors. It is difficult to make an accurate diagnosis over the phone. An examination can help ensure that your child receives the proper treatment.

Prescriptions for ADD/ADHD require a 24-hour notice. By Texas state law, the prescription must be in writing and filled within 7 days. ADD/ADHD prescriptions cannot be phoned in to a pharmacy. These prescriptions must be picked up at the office; they cannot be mailed. Please call during regular office hours to request a refill.

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TLC Pediatrics files claims with most insurance carriers. We participate with the vast majority of insurers in our area: private insurance plans, HMO plans, and PPO plans. Examples include but are not limited to Alliance Newtwork, Atena, BSA Network, Blue Cross/Blue Shield, FirsCare, Blue Choice, Cigna, IMS, United, and Untied Health. Please check with our offices AND your insurance company to verify that we do participate.

Many insurances require that you choose a Primary Care Physician (PCP) for your child, and may require that you use a specific lab or radiology facility, or set of referral/specialty physicians when needed. Some insurers require preauthorization for certain services or prescriptions. Please contact your insurance company and find out if you have any such restrictions and let us know. Employers choose different insurance coverage, and we may not know the specifics of your insurance plan. It is your responsibility to assure that your insurance and physician assignments are in order when you come to visit us.

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