239-573-2001

The Best Cape Coral Pediatrician
Caring, compassionate, personal health care your family deserves



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.

Welcome Letter
Patient Information
Consent Form
Medical Release Form
HIPPA Mission Statement and Notice of Privacy

Additional Information
  • Please bring these completed forms with you to the appointment.  Please do not mail them ahead of time.
  • Please bring your insurance card and driver's license to every appointment.
  • Without an insurance card we cannot file with your insurance company.
  • Several managed care plans may require a valid referral prior to appointment.  Contact your insurance carrier if you have further questions about referrals.
  • 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.
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.