You can print out these forms on your computer printer and fill them out. You'll need the Adobe Reader software to print them. Please bring the completed forms with you when you come to our office
|Authorization for Health Care of a Minor|
Fill out this form if some one who is not a legal guardian will be bringing your child to our office.
|Authorization to Release Patient Health Information|
Use this form to have medical records transferred.
Use this form when our office requests it.
If you are new to our practice, please complete this form and bring it with you on your first visit.
|Influenza Vaccination Screening Questionnaire|
Screening questionnaire for attenuated intranasal influenza vaccination or inactivated injectable influenza vaccination.
|Notice of Privacy Practices|
This notice describes how medical information about you may be used and disclosed, and how you can get access to this information. Please review it carefully.
If your child is new to our practice or if it has been more than a year since this form has been completed, please complete and bring to your visit.
|Pediatric Health History|
Use this form to give us a better understanding of your child's health history.
|Preparticipation Physical Evaluation|
If your child is going to participate in an athletic or other program that requires a physical exam, please fill out this form and bring it to the exam.
We will be adding more forms in the near future. Some of these forms may be completed on your computer. They must still be printed on your computer's printer and then the paper copy should be brought to our office.
The forms on this website are copyrighted and only for the use of Renton Pediatric Associates, P.S. and its patients.