School, Camp, Sports, Daycare, Travel Forms
Please take note of the following when requesting medical forms.
- Allow 5 business days to prepare each form
- Before dropping off any form, parents should complete all the parents’ portion of the form.
- In compliance with the Health Insurance Portability and Accountability Act (HIPAA), we can only send back completed forms by mail, fax, or picked up in person during our office hours. We cannot sent you a completed form via email.
- Our office currently do not charge for the completion of forms. To assist us absorb the administrative cost involved in filling these forms, please note that we can only give each patient one completed school form per calendar year. We advise that you make copies if you will be needing the completed form for multiple purposes, such as summer camp, before-and-after care, etc.
New Patients Forms
We encourage you to download, complete the new patients form and send to us ahead of your visit.
- Registration Form.
- Notice of Privacy Practices.
- Financial Policy.
- Financial Acknowledgement Form.
- Medical/Family History Questionnaire
- Medical Release Form – Please complete this form and send to your current primary care provider to obtain your child’s medical record.
Medical Release From KinderHealth
If you are requesting a release of medical record from us, please complete the form below and return to us.