Birth to 6 Years
The following forms are provided for new patients who would like to get the paperwork finished before they visit us. Please note that you may still have to fill out a form or two at your first visit depending on insurance provider and other circumstances.
- HIPPA Signature Sheet
- Notice of Privacy Practice
- Clinic Information
- First Visit – What to Expect
- Pediatric New Patient Information
- Birth History (For Ages Birth – 3 years)
- Pregnancy History (For Ages Birth – 3 years)
- Newborn History (For Ages Birth – 2 months)
- Infant History (For ages 2 months to 2 years)
- Pre-School History (For ages 3 years to 5 years)
- School-Age History (For ages 6 and older)
- Pediatric Consent to Treat
- Payment Policy
- Acknowledgement of Financial Responsibility