Billing and Insurance Inquires - Pedatric Associates of Lawrencevill

- Use PAL's online resources for new patients to preregister, make appointments, and familiarize yourself your child's immunization and well-check schedule.
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- PAL’s office is open Monday through Friday, 8am to 5pm, and most Saturday mornings. We see patients by appointment only for health checks, and consultations. Please call to make an appointment for sick visits.
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- Please allow our staff 72 hours to respond to your online inquiry. If you experience difficulty completing any forms, contact PAL by telephone.
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- The appearance of external hyperlinks does not constitute an endorsement by PAL of the linked web sites, or the information, products or services contained therein.
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Billing Inquiries

Payment Policy

PAL requests payment for all medical services provided at the time of your child’s visit, including all copays. Cash, check, and major credit cards are accepted.

Please complete and submit the following form and one of PAL's office staff will respond to your inquiry as soon as possible.

Fields marked with an asterisk (*) are optional. All other fields are required.

Contact PAL Regarding a Billing Inquiry

Parent's Full Name:*

Child's Full Name:*

Child's Date of Birth:*

Phone 1:*

Phone 1 Type:*

Phone 2:

Phone 2 Type:

Email Address:*

Contact Preference:*

Respond by Email
Respond by Telephone

Insurance Company:*

Insurance Policy #:*

Insurance Phone #:*

Description of Billing Problem:*

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