For your convenience, the following forms are available for printing and completion. To reduce the paperwork required during your first visit you can fill out the forms below, at your convenience, before arriving.

Additionally, forms describing our current Office Policies are included below. After completing the forms in one of the outlined methods, please bring the Family Information Sheet, Medical Questionnaire, and HIPAA Acknowledgement Form with you on your first visit for office processing and mail the Records Release Form to your previous physician's office to request that your child's records be sent to our office. 

If you wish to transfer your records from another office, you may use the Records Release Form.

Records Release Form

New Patient Documents:

HIPAA Notice

Office Information

TRICARE Letter

Patient Registration

Health History (Child)

Health History (Adolescent)

How Did You Hear About Us

Privacy Notice

Important Notice

 

Vaccines and Autism

Links to Other Information on Autism:

CDC MMR & Autism page
http://www.cdc.gov/vaccinesafety/concerns/mmr_autism_factsheet.htm

Thimerosal Table
http://vaccinesafety.edu/thi-table.htm

 

Minor Child To Be Seen Without Parent or Legal Guardian