Please take a few moments and tell us how we’re doing by filling out our online patient survey.
- Patient Forms – please print, complete and bring with you the forms listed under “All Providers” and “Pediatrics Associates”.
Please print, complete and bring the following forms to your appointment, along with patient forms listed above:
- New Patient Packet
- Patient Information Form
- Individual/Family History Database
- Acknowledgement of Notice of Privacy Practices Form
- Authorization for Release of Information and Payment of Benefits Form
- Disclosure Authorization Form for Release of Protected Health Information
- Financial Policy Form
- No Show Policy Form
- ADD Questionnaire
- Psychosocial Behavioral Assessment Questionnaire For Age 6
- Psychosocial Behavioral Assessment Questionnaire For Ages 7-10
- Psychosocial Behavioral Assessment Questionnaire For Ages 11-15
- Psychosocial Behavioral Assessment Questionnaire For Ages 16-21
Patient Health Portal
You’ll need a username and password. Please contact the office to get set up for access.
Access your Patient Health Portal here.
Our patient portal gives you the ability to:
- View educational documents and clinical messages
- Access patient questionnaires
- Request appointments, demographic and guarantor changes
- Update insurance changes
- Request a copy of your medical records
- Access your medical records