Helping you plan ahead
To help save you wait time at our offices, we’ve provided common forms to help you be ready for your child’s appointment.
If you are a new patient and want to complete the Patient Registration form, please send us your child's current immunization records before scheduling your first appointment.
Click on any link below. Then complete and submit the form online. Or print the form and fill out at your convenience.
Office Forms & Policies
- Consent to Treat Minor Children
- Consent for Medical Treatment, Assignment of Benefits and ROI Financial Responsibility
- Daycare/Preschool Form
- Medical Records Release
- Notice of Privacy Practices
- Notice of Privacy Practices Acknowledgement
- HIPAA Authorization Form
- New Patient Registration Form
- Physician’s Certificate for Minor Work Permit
- 2021 Financial Policy
- Registration Downtime
- Authorization for Use – Disclosure of PHI
- Authorization for Use – Disclosure of PHI to Cincinnati Children's Hospital Medical Center