Established Patients

Please bring your current insurance card.   *You will be asked to show your insurance card at every visit.

Please bring any forms (child care, school, camp, etc.) with you for your appointment.

If you have not already updated your demographics this calendar year, please download, print out, and bring to your appointment.


 

ESTABLISHED PATIENT FORMS

 

One Time Only

Pediatric History

Immunization Registry*

Opt Out Immunization Registry *(Only if above document not chosen)

 

Once a Year*

*Any changes on information should be updated at the next visit.

CCP

Financial Agreement

Consent to Treatment

Notice to Privacy Practice

 

Well Visits, 15 – 18 Months

M CHAT

 

Well Visits, 11 Years & Up

Presports Participation

 

Consent for Non-Custodial Adult

Consent to Treatment