Patient Forms
What to bring to your first visit?
We work hard to ensure that your child receives prompt medical care in a comfortable, child-friendly office setting. To help expedite the first appointment, we ask that you please bring your child's immunization records and be prepared to complete paperwork regarding your family medical history, your child's medical history, and insurance information.
We have our new patient forms available for download. You may print them, fill them out, and bring them to your child’s first visit at our office. If you are unable to print the forms, we have forms available for you once you come into the office.
When you come to our office for the first time, you will need to bring the following:
- Insurance Card and Policy Holder’s Current Information
- Parent’s Driver’s License or Identification Card
- Child’s Immunization Record
Patient Forms (English)
- Patient Demographics
- Authorization of Health Information
- HIPAA (Notice of Privacy Practices)
- Authorization to Use or Disclose Health Information (Medical Records Release)
- Newborn Questionnaire
Patient Forms (En Español)
- Informaccion del Paciente (Coming Soon)
- La autorización de la información de la salud y la autorización
- Acuso De Recibo De Aviso Sobre Privacidad
- Spanish Newborn Questionnaire
In order to view or print these forms you will need Adobe Acrobat Reader installed. Click here to download it.