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Premier Pediatrics

A member of the CHOC Primary Care Network

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We remain open to provide your child with safe care. Call (949) 733-2800 to make an appointment. Learn more

Patient Forms

To expedite your first visit with us just print and fill out the forms below before coming into our office.

Forms and Fees

We will be happy to fill out any form, including sports physicals and school forms. Please be aware that there may be a fee and may require about 5-7 days for completion. If you would like to send a copy of a patient’s medical records, you will need to fill out a medical release form.

General Forms
If your child is out of school because of an illness, we will provide you a school or work excuse for that illness when asked.

Patient Forms
We have our patient forms available for you. Please fill out or sign any portion that is needed to be filled out by a parent before faxing or emailing them to our office.

Medical Release Forms
You can email the signed form to ocpremierpediatrics@choc.org or fax them to (949) 733-2810.

Sending records
Please be aware that there is a minimum fee of $25 to release medical records.

Receiving records
Please bring your previous medical records with you prior to your initial appointment. Updated vaccination records are best to provide the best visit and care.

New Patient Forms
Please fill out the form with the new patient’s information and bring it in with you on the day of your appointment.

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  • Staying Healthy Assessment (0-6 months)
  • Staying Healthy Assessment (7-12 months)
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  • Staying Healthy Assessment (5-8 Year)
  • Staying Healthy Assessment (9-11 Years)
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  • New Patient Form
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CONTACT

(949) 733-2800
(949) 733-2810 (fax)
ocpremierpediatrics@choc.org

MEET

Call to meet our pediatricians
(949) 733-2800

ADDRESS

15825 Laguna Canyon Rd.
Suite 102
Irvine, CA 92618

OFFICE HOURS

Monday through Friday
8 a.m .to 11:30 a.m.
12:45 p.m. to 4:30 p.m.

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COVID-19 Vaccine FAQs: The American Academy of Pediatrics answers parents’ frequently asked questions related to the new COVID-19 vaccines. Read more

CONTACT
(949) 733-2800
(949) 733-2810 (fax)

ocpremierpediatrics@choc.org
OFFICE HOURS
Monday through Friday
8:30 a.m. to 12:30 p.m.
1:30 p.m. to 5:00 p.m.

First 3 Saturdays
9:00 a.m. – 12:00 p.m.
ADDRESS

15825 Laguna Canyon Rd.
Suite 102
Irvine, CA 92618

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