New Patients + Forms

Welcome to our practice. We are excited about the opportunity to care for your children. To provide excellent medical care, our practice requires previous medical records and a thorough medical history. Please print and complete the forms posted below and return to our office 2 days prior to your first visit. This will make your first visit less stressful and less time consuming. Please visit all sections of our website for additional information, including an introduction to our physicians and entire staff.

If you need assistance completing these forms, please feel free to call our patient coordinator or our office staff. You may also contact our Office Manager, Tiffany Mosley (email), for general questions about our practice or with any other concerns.

As a reminder, please mail or fax the record request to your previous doctor immediately because of the processing time. If you already have your children’s records, please bring to our office at least 2 days prior to the visit.

For your convenience, we have a contagious entrance for all patients with illnesses (fevers, rashes, chickenpox, colds, etc). The only exception to this is if your newborn is 4 months old or less, please enter the Well Entrance. We also have a handicap/stroller entrance at our rear parking lot entrance.   For your convenience,  you may use this if you wish to bring your stroller. Our patient coordinator will assist you with registering and information changes.

When Leaving the office , please exit through the waiting room you entered, for example if entering sick waiting room and you are sick, exit the same.

Thank you very much for choosing our practice. We are extremely confident in our medical staff and look forward to developing a relationship with your family.


Pediatric Health Center Staff

– – – PATIENT FORMS – – –

Welcome to the Practice Letter

New Patient Registration Form

Patient Intake Form

Appointment Policy

Notice of Privacy Practices

Immunization Schedule

Record Request / Release of Information

PBM Consent Form

Permission to Bring Child Form