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Frequently Asked Questions

New Patient, Scheduling and General Office Information

How old do you see patients?
As long as children are dependents of their parents / legal guardians, they are considered a pediatric patient. That is: living at home and going to school or away at college and are not married or have children of their own.

Are you taking new patients?
Yes, so long as they are under 18 years of age. This allows better continuity of care with your doctor.

When do I see the doctor after I deliver my baby?
All of the hospitals in the Lee Health Medical System have Specialists called Hospitalists. They will see your baby in the hospital and provide the most expert care to your infant. Other counties have similar services. Upon check into the Labor and Delivery ward, be sure to tell the staff that you are a patient of our practice. They know what to do from there. Also, please call to make your follow-up appointment on the day you are released. Newborns should be seen in the office within the first five days of life. If you are released before 48 hours of age, you should be seen in the office the following day.

Who can bring my child to the doctor?
For the first visit, it must be a parent or legal guardian. After that, with your written permission, any person is allowed to bring your child to the office. The forms are under the Patient Portal part of this website. Children over 18 years of age may sign for themselves.

How does the office work?
We try to provide continuity of care with you always seeing the same provider. Dr. Annette and Dr. Courtney are full time and work 4 days a week. Both providers have the same beliefs and practice guidelines as outlined by the American Academy of Pediatrics. You will receive the same high quality healthcare whenever you are in the office.

If you do not keep your first appointment in the office, this will result in dismissal from the practice. Once you are established with the office, you will be dismissed if you fail to keep two appointments. Both are examples of ‘no shows.’ Please see the ‘No Show Policy’ under the Patient Portal’s office forms. We ask that you give us twenty-four hours notice to cancel an appointment.

How do I make my appointments?
For well child care, your next appointment is usually made as you leave from your present appointment. For newborns, the doctor will let you know in the hospital on discharge day when you need to make an appointment. We recommend making appointments sooner than later so that your schedule can be better accommodated. As stated earlier, newborns should be seen within 5 days of life and if you leave the hospital before your infant is 48 hours old, you need to be seen the following day.

Is it hard to reschedule?
Not at all. We are a partnership with you in raising your children. We understand things come up and do our best to get you another appointment in a timely manner. We do ask for at least 24 hours notice for cancelling an appointment. There is a $50 no-show fee if you do not give us the courtesy of notifying us online, by email or phone (239-415-1131) to let us know you will not be making your appointment. Click here to send us a cancellation notice online.

Why do I need to keep well child appointments?
Annual physical examinations are recommended by the American Academy of Pediatrics and have been shown to increase the likelihood that your child will enjoy better health. Preventative Health Visits help you as parents with many of the problems you face in raising your child, protecting your child from disease and injuries and may discover problems that are better and more easily treated when diagnosed early, before complications occur.

Examples of some of the important information that is obtained during an annual physical examination (that are not done during a visit for illness or injury) include:

  • Growth measurements: Any irregularities here may be the forerunner of a serious metabolic, endocrine or kidney disease.
  • Screening tests for anemia, kidney disease, high blood pressure, lead poisoning, vision and hearing problems.
  • Anticipatory guidance and education including information about child safety, development and behavior problems that would allow you (the parent) to help prevent health problems from developing at all.
  • Immunization to prevent disease.
  • A thorough systematic physical examination from “head to toe.” Many medical problems may be found before the patient develops any symptoms (i.e. thyroid disease, heart disease, skin disorders, scoliosis, dental problems). Early detection can save time, money and most importantly the development of a more serious illness which may cause your child more pain and trauma.

Preventative Health Visits should be scheduled at:

  • 1 to 2 weeks of age
  • 1 month of age
  • 2 months of age
  • 4 months of age
  • 6 months of age
  • 9 months of age
  • 12 months of age
  • 15 months of age
  • 18 months of age
  • 24 months of age
  • 30 months of age, and
  • yearly thereafter from 3 to 21 years of age

When is the office open?
The office hours are Monday through Friday from 8:00 to 5:00. We can accommodate well child exams, sick appointments or just about anything else you might need for your child’s health.

After-Hours, Sick Visits and Emergencies

What happens after hours?
When you call the office after hours, you will hear a recording that will give you instructions. If you are looking for office hours, they are discussed in the message or go here. If you need to talk to someone urgently, the message instructs you to call our answering service.  They will take your information and relay it to a Nurse Practitioner who will call you back to discuss your child’s illness.  Your call will be returned within an hour.  If you have a life-threatening emergency, please call 911. The after hour messages are not for ‘non-emergent matters.’  Appointments, referrals, prescription renewals will not be accommodated on this message.

If my child is sick, will the office be able to see them?
Any life-threatening emergency, you should call 911 and should be taken to the emergency room. The office can accommodate sick visits daily. The earlier you call, the greater chance you have of getting the time you would like for an appointment. We will always accommodate all sick children who want to be seen. Our medical assistants would be more than happy to assist you in the decision of whether your child needs to be seen or not.

How are prescription refills handled?
Please call the office during regular business hours and have the following information available: name, date of birth, name of medication, pharmacy name, address and phone number, your name and reachable phone number. Please allow 48 hours as a minimum for all prescription renewals.  Prescriptions are renewed on the phone for patients who are current with their well child care / physicals or e-mail us the patient’s name, dob, name of medication, strength and daily dose, pharmacy name and parent name and contact number by clicking here.

When my child is sick, can medicines be called in?
Most illnesses are caused by viruses and can be managed by supportive medical care and time. Prescription medications are not without side effects. The best care for your child includes proper evaluation, diagnosis, and treatment. No prescriptions will ever be “called in”.

What if my child needs to be admitted to the hospital?
Both HealthPark Hospital and Cape Coral Hospital have Pediatric Hospitalists who provide the best care for your child. They keep us informed of your child’s illness and arrange follow-up once your child is released.

Why must my child be seen before I can get a test or x-ray?
In order to properly and accurately diagnose and treat any patient, your child must be seen and examined. Only after proper evaluation can appropriate labs and tests be ordered.

Special Medical Needs, ADD/ADHD and Allergy Immunotherapy

My child has medical problems. Can your office handle children with chronic diseases or illnesses?
We provide the best medical care in Southwest Florida. Most of the most complicated medical illnesses in children are provided care at MacKoul Pediatrics Fort Myers. We are comfortable in caring for any chronic illness including genetic abnormalities, asthma, allergy, wheezing, cystic fibrosis and diabetes, autism and asperger’s syndrome and many more.

Does the office take care of children with ADD or ADHD?
In general, yes, we do. However, if your child has complex ADD or ADHD, the doctor may not be qualified to prescribe and referral to a specialist may be involved.

Do you treat allergies?
Allergy immunotherapy has changed dramatically over the years. Research now shows that Allergy immunotherapy, which is allergy shots or Sublingual drops, is successful in treating allergies if given over a three year period. We not only treat, but diagnose allergies in the office with allergy testing and sublingual therapy. Call and ask to speak with one of the allergy nurses for more details. We would love to help your child’s quality of life change for the better.

Health Forms, Billing and Insurance

How do you you process school sports forms, camp forms and college forms?
The easiest way is during the actual exam. We can fill the forms out that day. If your child doesn’t need a physical and is up to date on their wellness exams, you can drop the form off and we will have it filled out within 48 hours.

Why do I have to pay when I come to the office? Sometimes even before being seen?
Your insurance company and the plan you have chosen dictate the rules around your co-pay or fees. This is not decided by us. We are legally obligated at each visit to collect your co-pay. We collect before your visit because often the children are crying after receiving vaccines and families want to get out and to their car as soon as possible.

Which insurance plans do you participate?
We are participating with many insurances. The easiest way is to check with your insurance plan. Dr. Annette M. St. Pierre-MacKoul’s name is a tough one to find many times. If you have any trouble, contact our office and they can give you her provider number so that you can register with your insurance company. Dr. Courtney Bayruns name is much easier to navigate with the insurance companies.

What are my options if I cannot pay my bill?
Please contact our billing department. Arrangements can easily be made ahead of time. It is more difficult when time goes by and the balance increases without any payments. We will work out a payment system that works for both of us. So long as regular payments are made, no collection action will be taken.

What if I don’t have insurance?
Our billing department will be happy to discuss with you the various options available.

What if there is a problem with my insurance company or bill?
Our billing department will be happy to discuss with you any issues that might arise.

Referrals and Specialists

How are referrals handled?
The best way to handle a referral is to see your doctor, discuss the problem and get a referral at your visit to see the specialist. Different insurances require different forms and are often done on the internet. Some require prior approval, so as you make the appointment with the specialist, call or email us to do the referral. This will avoid delays in getting approval from your insurance company.

What specialists does your office recommend?
The doctor will discuss this with you at your visit. If a referral is needed and your child is not up to date with well child check-ups, a physical exam should be done to assure that your child is seeing the proper specialist.


What types of immunizations does your office provide?
We provide the following types (each links to a comprehensive PDF from the Centers for Disease Control and Prevention):

When will my child need immunizations?
Simply refer to the The Department of Health (DOH),Center for Disease Control (CDC), American Academy of Pediatrics (AAP), and the Advisory Committee on Immunization Practices (ACIP) for their recommended immunization schedules for infants and children.

Are immunizations safe? Are they necessary?
Immunizations are the building blocks of pediatricians in their goal of preventative health care. We are in full support of the schedule devised by the American Academy of Pediatrics and the NIH / CDC. This is why we will only take care of children who are current on their vaccinations. If you have concerns, bring them up to your physician. We are happy to discuss any issues you may have concerning your child’s health.

How can I get a copy of my child’s immunizations (or medical record)?
This is a simple process with our Patient Portal. You can also call, fax or stop by the office for the same. The easiest way to get the school required forms is to obtain them at your child’s well child exam.

For a list of resources and healthcare-related links, please click here.