Other Forms

• Consent for TeleMdicine video call

• Confirm (Cancel or Reschedule) your appointment

• ADHD/ADD evaluation form.

• Depression Screen

• Anxiety Screen form.

• ​Request refill on medications.

• ​Upload files or documents.

• Immunizations consent form.

• Immunization refusal form.

• Blood pressure journal entry.

• Authorization to release medical records.

• Authorization to obtain medical records from another entity.

• Change of name (address or phone number) form.

• Authorization for non-Parent (non-Guardian) to accompany Patient.

• Medical treatment authorization for a minor​.

• Sport physical form.

• Head start physical form.

• Form 3300 (Certificate of Vision, Hearing, dental and nutrition screen).

Please click on the appropriate form listed above, enter your child’s name and your Email address then fill out the form and click submit, we will review the submitted form on same working day.