Thank you for visiting our website. To expedite the processing of your forms and save time during your visit, complete the patient intake form below.
You may choose either of the two options below:
A. KinderHealth Online Registration Form. You can quickly and easily complete and submit the forms on your smartphone, tablets, laptop without any need to download the form.
B. Fillable PDF forms – You can download the forms below and submit to our office via fax or email.
- Registration Form.
- Privacy Practices Acknowledgement form.
- 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.