Established Patients
We now offer tele visits to our established patients. Please complete the form below for consent to our tele-medicine practice.
Please complete this form when requesting that our office sends your child's medical records to another doctor's office.
Please complete this form if you need to make any changes to your address, phone numbers, e-mail, pediatrician, pharmacy or insurance information.
New Patient Paperwork
Please click on the links below to open each form. Please print and complete all forms, and either fax them back to our office or bring them with you to your child's appointment.
- Patient Registration Form
- Office Policies - please review our office policies carefully. If you have any questions or concerns, please feel free to ask one of our staff members.
- Authorization to Receive Information for Continuation of Care - this form allows our office to receive medical records from other medical offices where you child has received care.
- Permission to Treat - this form allows the parents to give permission for other people to accompany their child(ren) to our office.
- e-Prescribing Handout - our office uses e-prescribing to transmit most prescriptions to the pharmacy. Please read this handout to understand the benefits of this practice.
- Prescription History Consent - this form gives our office permission to electronically obtain all medications prescribed to your child.
- Acknowledgement of Receipt of Privacy Notice - you will receive a copy of our office privacy practices at your first appointment. If you prefer, you can sign this form when you arrive. Please bring a copy with you.
- No Show/Cancellation Policy - please review and sign our appointment no show and cancellation policies.