Forms/Files | Pediatrics & Adolescent Medicine, PC

Important Documents

Please click on the link ( ) associated with each document to print and fill out the documents as needed. If you have any questions, feel free to call out office for further guidance

Permission to Discuss Medical Information

Allows patients 18yr and older to authorize parents permission to discuss medical care (request appointments, obtain labs, etc.). Also allows parents to authorize a grandparent, aunt, etc. permission to discuss medical care (request appointments, obtain labs, etc.) for children under 18yr old.

School Form (Blue)

School form needed annually by schools for those children 5 years and older

School/Daycare Form (Yellow)

School form needed by daycare/schools for those children 4 years and younger

Medical Records Transfer:
Coming to Our Practice!

Please print and fill out this form if you are planning on joining our practice. Give us a call for further direction!

Medical Records Transfer:
Leaving Our Practice

Sorry to see you go! Please use this form to assist in moving your records to another practice or location.

Family Information and HIPAA

These forms must be filled out annually for each family. We will have them ready to be filled out at each visit. If you'd like, save time by printing them from here and filling them out before your visit!