Established Patients

Change of Insurance or Address - Please complete this form if you have a change of address or change of insurance and bring it with you to your next appointment.

Records Release FROM Growing Up Children's Clinic - Please fill out this form to have your child's medical records released FROM Growing Up Children's Clinic to a different pediatrician.

Permission to Treat - Update - If there are any changes to the individuals who have your permission to bring your child(ren) into the office for care, please complete this form.

Privacy Notice - If you have not read our Privacy Notice for your child(ren), please read the Notice, then sign the Consent to Treat/Medical Records/Privacy Form below and bring the signed form with you to your next appointment. You may keep the Privacy Notice at home for your reference.


New Patients
Physicals