FORMS
Forms & Documents
Below, you will find forms that can print and complete at home before your first appointment. New patients please arrive for your appointment 30 minutes early to complete the forms in the office.
Please bring the patient’s immunization records, medical records (if requested) and any pertinent court documentation.
One Per Family
Receipt Of Privacy Practices
Acknowledgment of receipt of privacy practices for understanding and compliance.
- 150 kb
Medical Records Release
Authorization for the disclosure of medical records for specified purposes.
- 110 kb
One Per Patient
New Patient Vaccine Form
Track and acknowledge child’s vaccinations, accepting responsibility for accuracy.
- 1217 kb
Ear Piercing Consent Form
This consent form must be completed before your child’s ear piercing can be performed.
- 54 kb
One Per Family
Privacy Practices
Track and acknowledge child’s vaccinations, accepting responsibility for accuracy.
- 93 kb
Financial Policy
Manage payment expectations, insurance details, and billing queries for services.
- 112 kb