Save time during your child’s first visit by having this insurance information form, a medical history form, office policies, and the consent form below completed for each new patient. You may bring completed forms with you to the office or fax them to us before your appointment.
Read the above notice of privacy practices, and bring in a signed consent form on your child’s first visit.
Please complete one medical history form for each new patient, and bring it in on your first visit.
Complete this form if you want your child’s medical records to be sent here from another office or facility.
Complete this form before your infant’s first visit to help us obtain his or her newborn metabolic screening results.
Bring this in for your child’s check-up if s/he attends or will soon attend school or daycare.
Please complete all questions on the first page. Write your child’s name and DOB on all pages. Bring this in for your child’s check-up appointment if he or she is 11 years of age or older.
Please complete this online questionnaire prior to your child’s scheduled checkup/well-child visit for all children from ages 9, 18, 30 & 48 months.