Welcome to MacKoul Pediatrics

Thank you for choosing MacKoul Pediatrics. We look forward to participating in your care. Please read the following details to prepare for your upcoming appointment. Prior to your appointment, we would ask that you take a moment to complete a few forms and bring them to your appointment.

What To Bring To First Appointment

Completed Forms. (Do not postal mail them ahead of time.)
- Welcome Letter
- Patient Information forms .
- Consent Form
- Medical Release Form , if applicable
- HIPPA Mission Statement of Notice of Privacy
Insurance Card. If you don’t have insurance or forget your card, you will be required to pay for all services at time of appointment
Driver’s License
Certified Birth Certificate for each child. Why?
Referral from another physician, if applicable
All examination self-payment fees, co-payments, deductibles and co-insurance fees will be collected at the time of service. We accept cash, check, MasterCard, Visa, Discover and American Express. You will receive a detailed receipt after your visit.

What To Bring To Appointments Following Your First

Insurance Card. If you don’t have insurance or forget your card, you will be required to pay for all services at time of appointment
Driver’s License
Referral from another physician, if applicable
All examination self-payment fees, co-payments, deductibles and co-insurance fees will be collected at the time of service. We accept cash, check, MasterCard, Visa, Discover and American Express. You will receive a detailed receipt after your visit.

Patient Portal for MacKoul Pediatrics, Cape Coral FL Dr. David MacKoul

Online Payment Portal at MacKoul Pediatrics

Consent to Treat a Minor Child

A biological parent or legal guardian must be present at the initial office visit and be present for the entire visit for any patient under the age of 18. Legal guardians MUST provide legal paperwork and have photo identification. After the initial visit, a grandparent or other caregiver may accompany the minor child with a Consent Form signed by the parent or legal guardian prior to visit.

Food and drinks are not permitted in the waiting room and examination rooms. We respectfully request that ADULTS AND CHILDREN COMPLY WITH THIS POLICY. This includes, but is not limited to: coffee, crackers, cereal, candy, cookies and sodas.

Reminder calls are executed 1-3 days prior to your appointment by the automated system. On rare occasions you may not receive a reminder call. In this event you are still responsible for keeping or canceling the appointment. Informing us of changes to your phone number and/or address assists us in our effort to reach you.

Cancellations of appointments should be made at least 24 hours in advance of scheduled appointment. Appointments may last up to 2 hours. Please plan your schedule accordingly. Appointments cancelled without 24 hours notice will be charged $50.

Late arrival of appointments : if you are more than fifteen minutes late for your appointment, you may be asked to reschedule. Because we understand your time is valuable we do our best to keep our schedule running on time. Please arrive promptly to ensure this courtesy to everyone.