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Downloadable Forms

IMG_2904.JPGListed below are some of our forms that you may be able to save time by filling out at home and bringing to your appointment. You will need Acrobat Reader to view these files.

New Patient Paperwork Packet (PDF)

If you are a new patient, please download and complete the above "New Patient Paperwork Packet" and bring it to your appointment.  Please also download and complete the following form for each additional child that you plan to enroll as a new patient with our office:  Additional Child New Patient Form (PDF)

Patient Update Packet (PDF)

Existing patients are asked to complete the "Patient Update Packet" once a year.  If you have not updated your information in the past 12 months or if you have an address/phone/insurance change please complete the "Update" packet and bring it to your appointment.

Protected Health Information (PDF)

If you need to update the individuals that can access your child's "Protected Health Information" or bring your child to the office please complete the above PHI form and drop it off at one of our offices. 

Well Child Surveys

In order to make your upcoming visit go as smoothly as possible, please click the above link and then select your child's upcoming Well Visit age to see if there are any surveys to complete prior to the visit.  They should be listed after "Please Complete Before Your Visit:".

Notice of Privacy Practices (PDF)

The above "Notice of Privacy Practices" describes how medical information about your child may be used and disclosed and how you can get access to that information.  

Flu Vaccine Screening Questionnaire

Please fill out the above form and bring with you to flu clinic if you would like to receive a normal flu shot.

FluMist Vaccination Consent Form

Please fill out the above form and bring with you to flu clinic if you would like to receive FluMist.