Forms

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.

Autism Screening

Use this form when our office requests it.

Financial Policy

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.

Patient Registration

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.