Forms

This document is editable but must be saved to your computer first. To do this, right-click on the “Download” button to the right, select “Save link as…” and selected a location to save the document. Browse to that location and double-click to open the document in Adobe Acrobat Reader.

Review document and then print and sign the HIPPA Acknowledgement below

Print and bring with you for your initial visit

Only needed if someone other than the parent/legal guardian is bringing the child in for treatment

Only needed if directed by office staff

Print and bring with you for your initial visit

Print and bring with you for your initial visit

Print and bring in for a sports physical