RESOURCES
Patient Resources
Our staff looks forward to meeting you and discussing your child's pediatric care. We strive to keep our appointments on time, as scheduled. Prior to your appointment, we encourage you to fill out the patient forms that are located on this website so that you can accelerate your check-in process. Please download, print and complete the forms and bring them with you to your appointment. If you are unable to download our patient forms, then it is recommended that you arrive to your appointment between 15-30 minutes early so that you can have ample time to fill out the appropriate forms.
Prescription History
Consent to Obtain Prescription History
Financial Policies
Information on Village Pediatrics' Financial and Office Policies
Health History Questionnaire
Medical and Family History Questionnaire
HIPAA
Authorization and Consent Agreement for Office Policies and Privacy Practices
Patient Information
Patient, Parent and Insurance Information Form
Portal Communication Release
Consent forms to use Patient Portal to access your child's records
Treatment Permissions
Caretaker Authorization for Medical Treatment
Consent to Treatment
Medical Authorization Form
*Individual results are not guaranteed and may vary from person to person. Images may contain models.