Forms

We use an electronic platform called Phreesia for appointment confirmation and registration via email or text message. We ask that this registration, which includes the paperwork below, is completed before you come into the office for your appointment in order to avoid any delay or possible cancelation.

Pharmacy Information

Financial Policy

Patient Demographics

Patient Medical History

Family Medical History

Vaccine Statement

Physical History Form (Ages 11+)

Medical Records Request Form

HIPAA Authorization for Release of Information

This form is completed to request patient records.

Medical Consent To Treat

This form is completed by a legal guardian if someone other than the legal guardian will be bringing a minor a visit.

HIPAA Release 18 yr and older

18 yr and older HIPAA Release Form Updated 5/16/25

Sports Physical Form

This form is completed at every wellness visit for children ages 11 and up.

Cardiac Risk Assessment

This form is completed at the 6 year and 9 year wellness visit.