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New Patient Registration Packets:

Newborn Packet

New Patient under 1 year old Packet

New Patient 1 year and older Packet

Individual Forms:

Registration Update

Family History Update

Authorization for Treatment

Health History less than 1 year

Health History 1 year and older

Financial Disclaimer

HIPPA Notice of Privacy Practices

Early Physical and Immunization Disclaimer

Release of Records:

Ask another provider to send your child’s records to our office

Kaiser and PAMF patients: Please note that these groups both require that you request your records directly from them. They will not accept a request sent by our office.

Ask our office to send your child’s records to another provider

Chart copying fee applies if you are transferring your child’s entire record. Subspecialist referrals are free of charge. Please note that patients who are 18 years and older must request their records themselves. We follow applicable laws regarding confidential information, some of which can be released only to the patient or another provider, but not to the patient’s parents.

Patient Care forms: (coming soon)

MCHAT for Autism Screening

Vanderbilt Scales for ADHD Evaluation

Asthma Control Test

Postpartum depression screening

Asthma Action Plan

Handouts: (coming soon)

Positional plagiocephaly (flat head)

Finger foods

Iron

Calcium

Calcium for Toddlers

Fiber foods

School, Daycare, Camp, and Sports Forms:

Forms for school, daycare, camp, and sports are filled out at the time of your child's appointment or within 1 week of receipt if they are given to us later. If your child has an ongoing health problem, we may need to call you or schedule an appointment in order to update his or her information before filling out a form. Please provide a self-addressed, stamped envelope or faxing/pickup information when you give us the form. Please fill out your portion of the form completely before giving it to us, as we often have to attest that we have reviewed the patient/parent’s portion of the form. Please see our Financial Disclaimer for the current FORM FEE, which will be waived if you bring the forms at the time of your child's well child visit or routine medication follow-up visit (i.e. Asthma medications, ADD medications, other chronic medications.) We will not fill out forms at “sick” visits.