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Patient Forms

General Information
• Privacy Policy

New Patient Registration
• Welcome Letter
• Acknowledgement of Receipt of Notice of Privacy Practices
• Guarantor Information
• Medical History
• Informed Consent/Pay Agreement
• Newborn Insurance Guide
• Vaccine Policy Statement

ADHD
• Teacher: Initial Form
• Teacher: Follow-Up Form
• ADHD Consult Letter
• Prescription Protocol
• Parent: Initial Form
• Parent: Follow-Up Form

Well Child Exams
Developmental Questionnaires:
• 6-Month
• 12-Month
• 18-Month
• 24-Month

Teenage Physical Exams: Examines para Adolecentes
• Minor Children's Confidential Healthcare Rights

Medical Consent-Release Forms
• General Release of Information