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Downloadable Forms

Make your visit to our office easy as 1  2  3...

1. Download the required form(s)

2. Fill out the forms

3. Bring everything with you and give it to the receptionist

If you are a first time patient, please fill out the following four forms:

New Patient Questionnaire / Nueva Cuestionario del Paciente

Office Encounter Record / Record Office Encuentro

Patient Information Sheet / Hoja de Información para el paciente

HIPPA Acknowledgement Form / HIPAA Formulario de reconocimiento

 

If there is anyone, other than the child’s legal guardians, that will have permission to make appointments, receive confidential information or make medical decisions for the child, please fill out the following form:

Consent for Care / Consentimiento para la Atención


 

If you need a copy of your medical records you need to fill out the following form:

Medical Records Release Form / Registros Médicos Formulario de Autorización

 

School Forms:

If your child’s school requires a ‘sports physical’ during the school year, please fill out the form below, or obtain it directly from the school:

Preparticipation Physical Evaluation / Preparticipación Evaluación Física


sports

 

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