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.
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.
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.
- ADHD Parent
- ADHD Teacher
- Lead Poisoning
- Caregiver Affidavit
- Staying Healthy Assessment (0-6 months)
- Staying Healthy Assessment (7-12 months)
- Staying Healthy Assessment (1-2 years)
- Staying Healthy Assessment (3-4 Years)
- Staying Healthy Assessment (5-8 Year)
- Staying Healthy Assessment (9-11 Years)
- Staying Healthy Assessment (12-17 Years)
Medical Release Forms
You can email the signed form to firstname.lastname@example.org or fax them to (949) 733-2810.
Please be aware that there is a minimum fee of $25 to release medical 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.
COVID-19 Screening Questionnaire