An emergency is a medical problem or concern that cannot wait until our next scheduled office hours. A physician is available every hour of every day.
For Life Threatening Emergencies call 911
For Urgent Care call (203) 327-1055 (24 hours a day, any day).
We encourage you to always call us first, because there is no faster way to get individual medical advice than from the doctor who knows your child and you. We can see you in the office or the emergency room as needed, and help coordinate your care wherever you are as we have access to your medical record at all times through our Electronic Medical Records.
If you have an emergency during office hours, be sure to say to the receptionist, “THIS IS AN EMERGENCY” and you will receive prompt attention.
After hours, when the office is closed, our voice-mail system will answer. Anytime during the greeting, you may press “1” on your touch-tone phone and you will be immediately transferred to our answering service. If you do not have a touch-tone phone, you will be transferred to the service at the end of the greeting. If there is no answer, all the lines to the service may be busy or there may be an equipment problem. In that case, please call again in a minute or two, or call our service directly at 1 877 295-8429
We return every emergency message. If you do not hear from us within a reasonable amount of time (less than 30 mins. except for some peak paging times) please call the service again. Occasionally names or phone numbers are recorded incorrectly.
In the case of a life-threatening emergency (e.g. severe breathing problems, seizures, serious trauma, etc.), go directly to the nearest Emergency Room or call 911; Once there, you or the hospital can contact us. Our office does not have the same facilities as a hospital does and after hours we cannot respond quickly enough in instances where every minute counts. We attend to our patients directly only at The Stamford Hospital (www.stamhealth.org).
In non life-threatening emergencies (e.g. cuts, fevers in young children, respiratory infections) please call us first and let us help you make the decision about where your child should be seen. Long waiting periods, treatment by a doctor unfamiliar with your child, and considerable inconvenience can be avoided when we coordinate your child’s care.
Do remember that since several health plans require you to contact us before going to the Emergency Room, it is a good idea to review your plan’s policies prior to any emergency.
All ingestion (poisoning) accidents are emergencies until proven otherwise. Do not wait to see if a child becomes ill, for then it may be too late. Call the Poison Control Center (800-222-1222) http://poisoncontrol.uchc.edu/ as soon as you discover a child has eaten something he should not. They have a complete database of almost all possible poisons or ingestions. They will inform you if you need to contact us or proceed immediately to the Hospital.
It is our belief that all parents should be trained in infant/child emergency care. Courses are offered frequently in our community by the Red Cross and The Stamford Hospital (203 276-WELL or www.stamhealth.org.) We would be happy to help you find an appropriate program.
Our main office is open during the hours listed below but not all services are available at all times and the office closes daily for lunch from 1:00 p.m.-2:00 p.m. It is necessary that the doctors work by appointment. The only exception to this is during the ‘walk-in’ hours described below. Appointment scheduling allows us the opportunity to allocate our time and proves most convenient for the patient. Unfortunately, patients do not become ill on schedule, some visits take more time than anticipated and emergencies do occur; hence, delays in schedule are inevitable. We make our best efforts to adhere to the schedule.
Upon arrival, please sign in and inform the receptionist of your arrival. It is essential that you inform us immediately of any change in address, telephone (home, work and cell phone numbers), insurance or name as soon as possible. We also think it is very important to keep a current email address on file so that we can keep you informed of up to the minute office information. We use this information to contact you in case of an emergency, and to contact you with test results in a timely manner.
Effective 9/23/2013, photo ID will be required when checking in, refill a prescription or picking up records in accordance with the new HIPAA rules.
Routine exams are scheduled in advance with a specific doctor of your choice and require significantly more time than sick visits. We schedule about 20 minutes of physician time per physical exam and do not “overbook”. Since the nurse will spend time with the parent and child both before and after the Doctor, expect to spend at least 40 minutes with each appointment. During peak spring and summer months please call at least 4-6 weeks in advance. Schedule Camp and School Physicals early in the spring. (See “Routine Examinations” below for ages of mandatory exams). Early morning and evening appointments are in greatest demand and are intended primarily for working parents who cannot easily make daytime visits.
|Monday-Thursday||9:00 a.m. – 6:00 p.m.|
|Friday||9:00 a.m. – 5:00 p.m.|
If you need to cancel an appointment, please inform us as soon as possible so that the time may be offered to someone else. Failing to do so more than 24 hours before your scheduled visit may incur a “missed appointment fee”. You may call the office directly during regular hours or leave a message on our voice-mail. We realize anyone can miss an appointment, if, however, two or more consecutive appointments are missed without prior notification you may be charged for a full office visit for the second and all subsequent consecutively missed appointments.
Sick Visits are available by appointment, usually the same day you call, (or by walk-in during walk-in hours). You may always request a specific doctor if he or she is available but do realize that such requests may result in fewer choices of possible appointment times. Sick Visits are problem-focused and are no substitute for comprehensive Physical Exams. Saturdays are reserved to see acutely sick children only. Chronic problems are better managed during a weekday visit. Call after 9:00 a.m. weekdays and Saturdays to make an appointment.
|Monday-Friday||9:00 a.m.- 5:00 p.m.|
|Saturday||9:00 a.m. – 12 noon|
|Sunday||Emergencies only (individual arrangements made with MD on call)|
|Monday – Friday||8:00 a.m. – 9:00 a.m. and 4:00 p.m – 5:00 p.m.|
|Thursday AM||No Walk-in Hours|
Walk-in visits are available during the above hours on a first-come, first-served basis. They are intended for brief focused problems only (earaches, sore throats, colds, etc.). We have little control over waiting time as it depends on the nature of the problems and the number of patients arriving (about which we have no prior notice). The receptionist can give you a rough estimate of waiting time on request. If more convenient, you can always make a scheduled sick appointment for later in the day. On days with excessive demand, we occasionally have to end morning walk-in visits before 9:00 a.m. in order to have physicians available for scheduled appointments. In that case one of our nurses will be able to schedule a visit for you later that day.
The office is closed New Years Day, Memorial Day, July 4th, Labor Day, Thanksgiving and Christmas. (a physician is always on call for emergencies)
Although we do our best to keep the office open despite weather or related problems, there could be times when staff is unable to travel and open the office. Please check the website www.ThePediatricCenterofStamford.com check us on Twitter (Pedctr) or check us on Facebook (ThePediatricCenterofStamford) for last minute changes in schedule. As always, a physician would be reachable through our answering service during that time.
Our office is equipped with a modern phone system with voice-mail service. The office is available directly by telephone:
|Weekdays||9:00 a.m.-1:00 p.m.|
|2:00 p.m.-5:00 p.m.|
|Saturday||9:00 a.m.-12 noon|
After Hours: See “Emergencies” above.
Best times to call: To reach us for routine matters (billing questions, Well Child appointments, non-urgent questions) please call:
|Weekdays||10:00 a.m.-1:00 p.m.|
|2:30 p.m.-4:00 p.m.|
Since families are often trying to reach us with urgent concerns first thing in the morning, directly after lunch and just before closing, please try to avoid those times for routine matters. We do not have a full staff on Saturdays and half-day holidays and so we prefer to handle only urgent problems on those days. You can also leave a voice-mail message after hours.
Voice-Mail: Our office has a private voice-mail system to allow families more flexible communications with us. This system allows busy families to leave non urgent, confidential messages with us at any hour. Those messages will be returned during the next regular business hours (voice-mail messages are generally not returned after hours on weekends and holidays). These messages can be left for any of the Doctors or Nurse Practitioners, for the Head Nurse, Office Manager, Billing Department, Appointment Desk, or referral desk.
Phone Nurse: One or more of our Nurses is available throughout the day for telephone advice and support. This service is one of our most valuable and popular. There are times, especially 9-10:00 a.m., when the Phone Nurse is quite busy with urgent questions. We endeavor to give each caller the time they need, so we must ask your patience during peak calling times. Often, we will ask to take a message rather than have you hold if too many of our phone lines are occupied. The phone nurse will then return your call as soon as possible.
Doctors: Except for urgent problems, we generally do not interrupt visits for telephone calls. The staff will be happy to take a message that will be returned at the earliest opportunity, or you can ask to leave a non urgent message in the doctor’s confidential voice mail. Messages are returned first in the order of urgency and then in the order they are received. We most frequently return routine messages between 1-2 PM or at the end of the day, after 5-6 PM. Please let the staff know when is the best time to call you back and do provide alternate phone numbers where to reach you.
(Please be aware that most insurance companies place a limit on the number of “well visits” that are reimbursed per year. Our recommended schedules take into account what is recommended by the American Academy of Pediatrics. Most, but not all, insurance plans work with this schedule as well.)
During the first two years of life, we see our patients at regular intervals for routine well baby examinations and immunizations.
After the two-year checkup we like to see children for a yearly examination around birthday time until age 5 years. From age five until puberty, we still recommend yearly exams, but please check with your current insurance plan to find out what is reimbursable. An exam every two years is usually reasonable unless children have ongoing or new medical conditions (e.g. asthma, allergies, heart problems, growth concerns, or developmental or academic issues) or take daily or frequent medication: for those children, we strongly recommend yearly visits at a minimum. After each visit, we will suggest to you and your child when the next routine visit should be. Naturally, you should feel free to call us or arrange a visit sooner if new concerns arise.
During the teen years, we once again suggest annual exams. One of our primary functions as pediatricians is counseling and guidance. We can be much more helpful to adolescents if we maintain a relationship with them as they are growing and developing.
Some of the state and local school forms are available on our website…. Feel free to download them at your convenience.
Effective 1/1/2014, there will be a $10 fee per form per child. This includes school, camp, medication, allergy protocols, etc., whether sent in or brought in at the time of a visit. There will be a $20 cap per child when more than 2 forms are given at the same time. Forms mailed in still require a one week turn-around time and an enclosed check, along with a self-addressed stamped envelope.
We will continue to offer our “Urgent Form” option for all forms that need to be completed within 24 hours or less for a $20 fee per form with a $40 cap per child for forms completed at the same time.
No charges will be billed so payment must be made prior to forms being released.
During the spring and summer we receive hundreds of forms. Please allow at least one week for the forms to be completed. If your child is missing a required examination or immunization, we will inform you as soon as we can. (See “Routine Examinations” above.) Spring and summer are our busiest times for routine exams. Please determine if your child needs an exam and call us as early as possible as there may be a significant wait for appointments between May and September.
Connecticut public schools require a mandatory physical exam before entry into Kindergarten, 6th grade and 10th grade or at any entry into a new school system. In addition, public high school athletes are required to have a comprehensive exam before September of the year they participate in competitive sports. As a matter of law, public schools cannot allow your child to enter school or play sports without a required exam and immunizations.
Private schools may mandate more frequent exams, preschools usually require annual exams and camps usually need one every two years. Many camps and schools have their own idiosyncrasies, please check their requirements well in advance and remember that there may be several weeks before we have an available time for a physical exam in the spring and summer.
Immunizations are the basis of preventative medicine. It makes sense to prevent the very serious illnesses: for some of these serious viral illnesses such as measles or mumps, there are no available treatments, only supportive care. Many carry devastating consequences such as meningitis, neurological sequellae, or death, so prevention is of utmost importance.
We firmly believe in the effectiveness of vaccines to prevent serious illness and save lives.
We firmly believe in the safety of our vaccines.
We firmly believe that all children and young adults should receive the recommended vaccines according to the schedule published by the Centers for Disease Control and the American Academy of Pediatrics.
We firmly believe, based on all available literature, evidence and current studies, that vaccines do not cause developmental disabilities or autism.
We firmly believe that thimerosal, a preservative that has been in vaccines for decades does not cause developmental disabilities or autism. However, none of the vaccines that we offer in this office contain thimerosal.
We firmly believe that vaccinating children and young adults is the single most important preventative intervention we perform as health care providers. The recommended vaccines and their schedule are the results of many years of scientific study and data-gathering on millions of children by thousands of our brightest scientists and physicians.
These things being said, we recognize that there has always been and will likely always be controversy surrounding vaccination. The vaccine campaign is truly a victim of its own success. It is precisely because vaccines are so effective at preventing illness that we are even discussing whether or not they should be given. Because of vaccines, many of you have never seen a child with polio, tetanus, whooping cough, meningitis or even chicken pox. Such success can make us complacent about vaccinating. This attitude, if widespread, can only lead to tragic results.
Over the past several years, some people have chosen not to vaccinate their children or vaccinate on alternative vaccine schedules. Unfortunately, some of these decisions were made based on one flawed study that was later formally retracted, in which it was suggested that the MMR vaccine caused autism. As a result, there have been outbreaks of all of these preventable illnesses, leading to deaths and disabilities from complications of these diseases which should never have occurred.
Counting on others being vaccinated to protect those that are unvaccinated is unacceptable. Vaccines work best when each person in a community commits to preventing spread of communicable diseases.
We have carefully thought through our office policy and are confident that in choosing our practice you agree with our medical reasoning and recommendations. We recognize the choice may be an emotional one for some parents. We absolutely believe that vaccinating according to the schedule is the right thing to do. However, should you have doubts, please discuss these with your physician in advance of your visit. We require that you commit to actively vaccinate your children and commit to a schedule that is completed by age 2 years at the latest. Please be advised that “spreading out the vaccines” to give one or two at a time goes against expert recommendations and can put your child at risk for serious illness and death and goes against our medical advice.
If you and your provider have discussed and agreed to adopt an alternative vaccine schedule, it is your responsibility to inform the office of your child’s under-vaccinated status during any sick visits or phone calls, especially if your child has fever.
Finally, if you absolutely refuse to vaccinate your child, we will ask you to find another practice that shares your philosophy.
As physicians, we feel strongly that vaccinating children on schedule, with currently available vaccines, is absolutely the right thing to do for all children and young adults.
The current recommended schedule of vaccines and visits is available at the office as well as on the link below.
If immunization schedules are followed, it is not necessary to have a Tetanus booster every time there is an injury. Wounds at greatest risk of Tetanus infection are punctures, large burns and scrapes. Most children receive a Tetanus booster, given as a DPT at age 5 years before entry into Kindergarten. Even for a high-risk wound, children do not need Tetanus boosters if they have received a dose of DPT or DT within five years of the wound and received at least 3 total doses since birth (most have received 5). Tetanus should be boosted every 10 years, even for parents!
Adolescents and adults need immunizations too. Diphtheria, tetanus, pertussis, along with meningococcal vaccine are required at age 11 and entering 7th grade. Human papilloma virus, hepatitis A and tuberculosis screening are all reviewed and discussed.
There are a number of vaccines that are not routinely required but are suggested in certain circumstances such as exposure to certain contagious diseases and foreign travel. If you plan to travel outside the country, we suggest that you consult the Center for Disease Control (CDC) International Travel Hotline (404-332-4559), or visit their website at http://www.cdc.gov/travel. Do call us one month prior to departures to review your individual needs, and schedule for any needed vaccines or preventative medication.
The influenza vaccine is given yearly as soon as it becomes available, typically in late summer. As of 2009, the Influenza vaccine is strongly recommended for all of our patients 6 months and older with few exceptions. Two formulations are available and are discussed during visits as to their suitability: the classic injectable form, and a live virus version, given as a nasal spray.
It has always been our policy to discuss risks and benefits of all vaccines given to our patients before they are administered and to provide patients with written information sheets for each administered vaccine. We trust that this process will make you comfortable with a vital part of your child’s preventative health care.
The quickest way to get a prescription refilled, if any refills remain, is to call your pharmacist directly and give the prescription number from the label. If the prescription is not refillable, use the patient portal or call our office during regular hours for a new prescription (See best times to call, above). Please do not wait to the last minute to call for a refill. If possible, please have the old label available as well as telephone numbers for any out-of-town pharmacies.
Regulatory changes regarding controlled prescription medications. (These include drugs such as stimulant medications for ADD, narcotics, sedatives and others.)
CT law now mandates that these drugs must be prescribed using the electronic e-prescribe system. Paper prescriptions will not be accepted.
In addition, prescribers now need to access and search the CT Prescription Monitoring website when these medications are ordered.
Due to the added time and labor involved, the Pediatric Center asks that you make your controlled prescription requests at least three days in advance.
For last minute, emergency requests, there will now be a $30 fee.
Remember: We continue to require an office visit every three months if we are prescribing stimulant medication for our patient.
Effective 9/23/2013, photo ID will be required when checking in, refill a prescription or picking up records in accordance with the new HIPAA rules.
We will make house calls when indicated. Most often, a more thorough examination, testing and treatment is available in the office or at the emergency room depending on the need.
It is our earnest desire to provide you with pediatric care at a fair fee. We always welcome any discussion of fees although copays are fees set by insurance companies and are not negotiable: we must follow strict guidelines in their administration in order to submit your claims..
Our current fees are available from the office staff. It is difficult to give a set value for many of the services that we perform. In general, consultations and services that require additional time will warrant a larger fee. There are also extra charges for services performed outside of regular office hours including sick visits after 5 PM weekdays and on Saturdays, Sundays and Holidays. Hospital care charges are based on the amount of time required and vary with each situation. At this time, we do not charge for telephone consultations, but we do charge for late night telephone triage services by pediatric nurses. We are charged a per call fee by these services and we simply pass on these charges to our patients when the service is used.
It is always our policy that any payment due (including co-payments for families on HMO/PPO/Managed Care Plans) is required at the time services are rendered (except for hospital care). The parent or guarantor (insured member of the household), is responsible for payment for services provided by the Pediatric Center at the time they are rendered. The only exception to this policy is if The Pediatric Center has contracted with a managed care organization/HMO/PPO to accept the insurance payment as payment in full, after you have met your deductible, if any, and have made all co-payments, if required. We will require a copy of your insurance card and billing information. Please bring the card with you at each visit. If you change plans, please inform us immediately. If you fail to inform us of any changes in coverage, you will be responsible for payment of services rendered. We will balance bill you per your insurance plan.
It is our policy that the person bringing the child to our office is responsible for payment at the time of the visit for services rendered, regardless of which parent has the ultimate legal obligation to pay for medical care. It is the parents’ sole responsibility to settle these financial matters between themselves and caregivers.
You may also be responsible for ancillary charges such as laboratory testing, vision screening, etc. per your insurance coverage.
Financial hardship can happen to anyone. You may ask to speak to our business manager at anytime to discuss alternate payment schedules. Our aim is to help you meet your financial responsibilities without putting the care of your children in jeopardy.
The following are fees for services rendered at the Pediatric Center (as of 1-2012) that are not always billable to insurance companies. These fees are subject to change without notice.
|Billing Fee (for co-pays not paid at the time of service)||$10 (in addition to co-pay)|
|Missed Appointment Fee (appointments not cancelled 24 hrs in advance)||$50|
|Missed Appointment Fee for “counseling” appointments not cancelled 48 hours in advance||$100|
|Telephone Consults to Night Triage Service (9PM-8AM) will be directly billed to you||$20|
|(billed directly to the patient since these are not a covered expense by insurance carriers)|
|Copy of Medical Records first copy is free, – if picked up at the office. Thereafter charges per CT law, currently at $.65 per page plus postage for paper or electronic records if mailed||first copy is free|
|Then $.65 pp plus postage
|Records Retrieval Records may be destroyed 7 years after last date of service per CT Law.||see above|
Effective 1/1/2014, there will be a $10 fee per form per child. This includes school, camp, medication, allergy protocols, etc., whether sent in or brought in at the time of a visit. There will be a $20 cap per child when more than 2 forms are completed at the same time. Forms mailed in still require a one week turn-around time and an enclosed check, along with a self-addressed stamped envelope.Urgent Forms that need to be completed within 24 hours or less require a $20 fee per form with a $40 cap per child for forms completed at the same time.
|VFC/State Vaccines available for those who qualify: $21/administration fee per dose (CT statute)|
|Returned Check Fee||$30|
We have contracted with various HMO/PPO organizations. We provide the same quality of care with the same availability to all of our patients regardless of their participation in HMOs/PPOs. While these organizations can provide significant cost savings to your family, most have specific procedures which must be followed. Please take the time to familiarize yourself with the specific policies and requirements of your family’s plan. Should you belong to a HMO/PPO, please alert our staff. Your plan may have some restrictions on service that we need to know about. If we participate in your HMO/PPO, we will bill them directly, although you may be responsible for a co-payment or deductible due at the time of the visit. Please bear in mind the following:
1) If you join or change plans, please inform us immediately. Most companies have strict deadlines for filing claims. If you do not inform us of your status in time to file a claim, you will be responsible for the balance.
2) Please bring your insurance cards (and any other cards e.g. lab, pharmacy) with you at each visit.
3) Many plans require prior approval of non-emergent visits to specialists, hospitals, laboratories and allied health professionals (e.g. physical therapists, psychologists, audiologists). Please discuss these referrals well before any scheduled appointments as it can take hours and, in some cases, days to process approvals by some plans. Please note that we will not approve referrals that were not discussed with us in advance.
4) Many plans require us to use only certain labs or hospitals or do not allow us to perform some testing in our office. If you fail to notify us of your coverage and services are done by an institution not approved by your new plan, you will be responsible for the charges.
5) Many plans have varying deductibles that will be your responsibility. We typically are not informed of deductibles until after we have submitted a claim. In such cases we will bill you directly after the claim is returned to us.
6) Many plans cover only a certain number of visits at certain ages (i.e. physical exams every 2 years after age 6 years) or do not cover some services. Unfortunately, many schools, camps, etc. require annual physicals for participation in certain activities. Payment for requested services not covered by your plan will be your responsibility.
Unfortunately, some of our families become involved in divorces. We do our best to provide whatever support we can for the child and the family. First and foremost, however, we are the child’s advocate and will not become involved in disputes between the parents except where we believe the child’s welfare is at stake.
Divorce does not eliminate the parents’ financial responsibility for a child’s medical care. It is our policy that the parent or person bringing the child to our office is responsible for payment at the time of the visit for services rendered regardless of which parent has the ultimate legal obligation to pay for medical care. It is the parents’ sole responsibility to settle these financial matters between themselves.
We have been using electronic medical records since 2007. This enables us to keep organized, accurate, legible, safe, private, and accessible records for each of our patients.
If requested, we will gladly review our records with parents or children at a mutually convenient time.
We will make available copies (we always retain originals) of our medical records to a parent, patient or third party only upon written request. We have forms available in the office and on our website for such requests or you may send us a signed and dated letter detailing which records for which child you wished copied and where you wish them sent. We also require specific additional written consent to send information regarding psychological or psychiatric reports and HIV status. In general, we do not copy records of previous physicians in our files. You should request them directly from the other physician. We may charge a per page copying fee and postage fees (if the records are mailed). These fees are set by Connecticut Law.
Please note that most insurance companies keep your signed record release on file and may request information at any time. They also frequently send representatives (usually nurses) to review medical records at our office for quality assessment and other measures. If you do not wish your records sent to or seen by a third party without specific permission, please inform us. Such action may result in considerable delays processing your claims.
We take care to ensure that records are complete and are reviewed by a physician prior to releasing them. The process is time-consuming. Therefore, please allow at least one week for records to be sent out. Copies of our records are not immediately available on demand, except in medical emergencies.
Effective 9/23/2013, photo ID will be required when checking in, refill a prescription or picking up records in accordance with the new HIPAA rules.
Regular patients that are minors can be treated in the office if accompanied by an authorized person only. Consent forms will be provided by our staff. Adolescents over the age of 16 years may come alone. In an emergency or if a significant problem exists we will do our best to contact a parent. We will never withhold necessary care in an emergency even if we cannot reach you.
Effective April 14, 2003, all medical entities are required by federal law to follow The Health Insurance Portability and Accounting Act (HIPAA) regulations regarding patient health information for the maintenance of the privacy of patients’ medical records.
We at the Pediatric Center, understand that your medical/health information is personal and private. In order to provide you with quality care and to ensure compliance with certain legal requirements, we create a record of the care and services that you receive in our office(s). We respect the privacy and confidentiality of medical/health information about you and that can be identified with you. This is called “protected health information”. Your protected health information is contained in the medical and billing records maintained by our practice. It includes demographic information and information that relates to your present, past or future physical or mental health and related health services.
Notice of our privacy practices and forms will be given to all patients. We ask you to sign the forms and return them to our staff.
We of the Pediatric Center of Stamford are here to serve you and your children. Please do not hesitate to speak to one of us if you have medical questions or other concerns. You can help us by remembering these important things:
1. Telephone as far in advance as possible for appointments.
2. Be on time for appointments.
3. When unable to keep an appointment, let us know as far in advance as possible.
4. Feel completely free to discuss fees or policies at any time. We want our patients to understand them and feel they are reasonable.
5. Tell the receptionist when you come to the office about any change in your address, phone number, email, or insurance coverage since your last visit.
6. Feel free to report to the doctors, the head nurse, or the office manager any complaint that you may have about our charges, services, or personnel.
7. Read carefully all information from your insurance company as most companies require more and more responsibility and effort from the patient. While we will do our best to assist you, coverage varies significantly even within a given insurer and changes frequently. Please bring your insurance and any other coverage related card with you to each visit.
But especially….do enjoy your children!!