Completing forms before you visit
To help us provide excellent care and bill your insurance company for services, please complete the forms below. If you are visiting the office for a Well Child Check, please also fill out the age-appropriate form. To complete forms:
- Fill out the forms using Adobe Reader. If you need to download the software, click here to access the free Adobe Reader.
- Email completed forms as attachments to firstname.lastname@example.org. We will put the information in your child's Electronic Medical Record (EMR).
If you have any questions, please contact Beth through the patient portal.