image
Patient Forms

We are excited that you have chosen Suffolk Pediatric Associates, P.C. for your child's medical care. Your comfort and convenience are our priority, and we strive to make every visit to our office a positive experience. To help you get acquainted with our office and first visit procedures, we have included helpful information on this page.

Patient Forms

To expedite your first appointment, please arrive a few minutes early to complete registration forms so that we have all the necessary information to treat your child. You may also download and print the forms from this website, fill them out ahead of time, and bring them with you to the first appointment.

Adobe Acrobat Reader Download In order to view or print these forms, you will need Adobe Acrobat Reader installed. Click here to download it.

Our Policies & Insurance

If you have insurance we ask that you please bring your information with you on your first visit. All insurance does not provide the same benefits. We are in-network for the following commercial insurance plans:

  • AETNA
  • BLUE CROSS/BLUE SHIELD
  • CIGNA
  • EMBLEM (NOT IN ANY SELECT CARE PLANS OR MEDICAID/CHILD HEALTH PLUS PLANS)
  • EMPIRE (NYSHIP)
  • FIDELISCARE (THROUGH AFFORDABLE HEALTH CARE)
  • GHI (NOT IN ANY SELECT CARE PLANS)
  • HIP (NOT IN ANY MEDICAID OR CHILD HEALTH PLUS PLANS-NOT IN HEALTHCARE PARTNERS OR HERITAGE) We have to be listed
  • ISLAND GROUP
  • LOCAL 1199
  • MAGNACARE/OSCAR
  • MERITAIN HEALTH
  • MULTIPLAN
  • OXFORD (FREEDOM & LIBERTY NETWORK)
  • PHCS
  • TRICARE
  • UNITED HEALTHCARE

We participate with the following Medicaid & Child Health Plus plans:

  • FIDELIS - We must be listed
  • HEALTHFIRST -We must be listed
  • BLUE CROSS BLUE SHIELD CHP - We must be listed
  • UNITED HEALTH COMMUNITY PLAN - We must be listed
  • MEDICAID

We are affiliated with:

  • Good Samaritan Hospital (West Islip, NY)
  • Southside Hospital (BayShore, NY)

***Remember, some insurance plans require that you name a PCP. Please name either Dr.Woletsky or Dr. Zanolin. We try to keep wait times to a minimum by verifying insurance prior to every visit. We will attempt to contact you should a problem arise. The copay and any previous balances are taken at the time of Check-in. If you have any questions regarding insurance or balances don’t hesitate to contact the Billing department.

We do our very best to let you know if something will not be covered by your insurance. It is also your responsibility to know if you have a deductible, how much it is and if it’s been met. We will bill you for any procedure that your insurance company puts toward a deductible after we receive an explanation of benefits from them. It is the insurance company that determines what is put toward a deductible as well as the amount we are allowed to bill you. If you need a copy of the EOB, contact Billing at ext. 22.

All co-payments are due at the time of the visit. For your convenience, we accept cash, personal checks, credit cards (Master card and Visa Only). It is important that you know what insurance you have when you make your appointment. All non-covered services are your financial responsibility. If your insurance carrier requests a Primary Care Doctor- we must be named. It is office policy that all insurances are verified prior to your visit, therefore if we are not listed as the PCP your visit may be delayed.

Please be aware that the parent bringing a child to the office will be financially responsible at the time services are provided. For your convenience, your bill may be paid in cash, check or credit card. In the event that someone other than the parent brings the child to the office, we ask that you please make arrangements for the bill to be paid at the time of the visit.

We ask that all prescriptions and authorizations for renewals be requested during normal office hours. Please have the following information available: the child’s approximate weight, allergies to medications, any medications the child is currently taking, and the pharmacy phone number. If this call is a renewal, please have the name, strength, and directions for the medication of if possible the Rx number located on the label.

We appreciate your cooperation in advance.