Patient Forms

Patient Forms

Forms

The following forms to be filled out by a provider require the child to have had a well-child check up in the last twelve months:

  • School/Daycare Physical Forms
  • Sports Physical Forms
  • Administration of Medication Forms
  • WIC Forms
  • FMLA Forms

Medical Records

When requesting your child’s medical records, the following may apply:

  • Click here for the form required to request your child/children’s records be sent to Child Life Pediatrics, PC.
  • If you need to request your records from our office to be sent to another doctor, please obtain a record request form from that physician’s office and either mail or fax the request to us.
  • Immunization records and WELL visit summaries are available for free on OUR PATIENT portal.

Prior to becoming a new patient at our office, the following New Patient Information packet will need to be filled out in our office before any patient can be EXAMINED by Dr Cadet. We encourage you to get a head start by completing this information prior to your appointment and bringing it with you to your visit. In addition, please do not forget to bring your insurance card with you.

You may download the forms below for your convenience.

New Patient Registration Form

New Patient Medical History Form

Permission to Treat Form

Authorization to Release Medical Records

Notice of Privacy Practices

Financial Policy