Some requests for paperwork may be requested online, instead of calling the clinic (click on link below).

PLEASE ALLOW 24 HOURS for your request to be completed before calling to inquire about it.

Click here to request a SHOT RECORD (121 FORM) or other form.


Please click a link below to open and print a PDF to complete before your visit.

New Patient Forms

For your convenience, new patient forms are available for immediate PDF download or online submission.

New Patient Packet (Includes the 4 files directly below)
New Patient Registration Form

Release to OPG
New Patient Health History
Missed Appointment Policy

Medical Release Forms

To release medical records every doctor’s office needs written permission to do so. Please print your copy, sign your release and email or fax it back to us. We work as quickly as possible to complete requests for medical records, but due to the size of some records we cannot complete these requests immediately. If you have moved out of the area we can fax or mail your child’s records to you or your child’s new pediatrician. If the records are voluminous they must be mailed. Depending on the cost, you may be charged for postage.

Release to OPG
Release from OPG

Sports Physical Forms

Sports Physical Form
(Parent/Guardian – please complete page 1)

Attention Deficit/Hyperactivity Evaluation Forms

For children being evaluated for school or behavioral issues and have not been diagnosed with ADHD:

Parent Form (Child NOT on Medicine)
Teacher Form (Child NOT on Medicine)

For children who have already been diagnosed with ADHD and are currently being treated:

Follow Up Parent Form (Treating with Medicine)
Follow Up Teacher Form (Treating with Medicine)