New Patients

Goldsboro Pediatrics > Forms > New Patients

Patient Code of Conduct

We ask all patients to follow these guidelines so you and other families have the best experience possible in our office.


Arrive on time. Please arrive on time for your appointment. If this is your first visit, plan to arrive 10-15 minutes before your scheduled time. If you are more than 15 minutes late we may ask you to reschedule.


Cancellation notice. Notify us at least 24 hours in advance to cancel. Last-minute cancellations are acceptable from time to time. In all cases if you cannot come to your appointment you must tell us before. Remember that your child’s health could suffer, and there could be medical consequences, if you do not keep appointments.


Respect other patients. We expect everyone to remain friendly and calm in our office. If you have a question or problem regarding someone else’s child, alert our staff so we can address it. Never engage in aggressive behavior toward another parent or child or you may be asked to leave our office. Do not leave your child unattended.


Electronics. Cell phones should be on silent. If you must answer a call please do so outside. Put away your device during conversations with our staff.


Payment. Co-pays and deductibles must be paid at the time of your appointment.


Medical issues. Alert our office staff to ANY medical issues that need immediate attention. You should do so at the time of your check in.


Hygiene. If your child needs a diaper change, vomits, has diarrhea, or other accident, please let our office staff know.


A parent or guardian must come with their child to every appointment.


Vaccine policy

Science and medical experience have proven that vaccines save lives, protect against illness, and stop deaths from preventable diseases. Not immunizing your child risks your child’s health for life, and may also threaten the health of your family. Moreover, you may cause others to become sick from a preventable disease.


We require our patients to follow accepted medical guidelines for vaccinations. Your child must have these vaccines to be seen by our providers:

  • DTaP vaccine to help protect against diphtheria, tetanus (lockjaw), and pertussis (whooping cough).
  • Polio vaccine to help protect against a crippling viral disease that can cause paralysis.
  • MMR vaccine to help protect against measles, mumps, and rubella (German measles).
  • Varicella vaccine to help protect against chickenpox and its many complications including flesh-eating strep, staph toxic shock, and encephalitis (an inflammation of the brain).

These vaccines are recommended:

  • Hepatitis A and hepatitis B vaccines to help protect against serious liver diseases.
  • Rotavirus vaccine to help protect against the most common cause of diarrhea and vomiting in infants and young children (and the most common cause of hospitalizations in young infants due to vomiting and diarrhea).
  • Hib vaccine to help protect against Haemophilus influenzae type b (a cause of spinal meningitis).
  • Pneumococcal vaccine to help protect against bacterial meningitis and infections of the blood.
  • Influenza vaccine to help protect against the flu. This vaccine is recommended for all people beginning at 6 months and older
  • Meningococcal vaccine to help protect against very serious bacterial diseases that affect the blood, brain, and spinal cord.
  • HPV (human papillomavirus) vaccine to prevent viral infections in teens and adults that cause cancers of the mouth and throat, cervix, and genitals.


Vaccine Refusal Policy

  1. All infants are required to be up to date on all recommended vaccines according to the AAP/CDC guideline by age 6 months and 2 years.
  2. Alternative schedules are acceptable, but not encouraged; however, may be approved at the discretion of the provider.
  3. Parents who refuse vaccinations will be given the vaccine refusal packet at the time of the visit and the visit will be completed.
  4. The provider will contact Michael to send a Vaccine Letter to the patient. If the parents are considering, then a Vaccine Warning letter will be sent, but the patient will not be terminated.  If the decision to not vaccinate is final, the patient will receive a termination letter.
  5. Parents who refuse to comply will be asked to find an alternative medical home for their infant and the infant will be dismissed from the
  6. We will continue to care for other children in the family if so desired by the
  7. Children who are over the age of 2 years and are not fully vaccinated will be dismissed if the parents refuse further catch‐up vaccinations. This includes new and established patients.
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