Policies
- Financial policy-VP1 2022
- Policy Forms 2022
- Appointment Policy
- Notice of Privacy Practices
- Walk-In
- Authorization for release of Medical Records
- Fluoride Varnish
- Telemedicine Consent
Patient Forms
We are happy to provide our office forms for convenient download on your home computer. Please print and complete the forms below, and bring them with you to your child's first appointment. Questions about which forms you need? Please call our office and our courteous staff will assist you in preparing for your child's first visit.
First Appointments:
- Patient Registration Form
- Patient Past Medical History
- Family Medical History Form
- Signature Sheet
- Cardiac Risk Assessment Form (kids 10 and up)
Check Ups:
- Patient Registration Form
- Family Medical History Form
- Signature Sheet
- Sports & Cardiac Risk Assessment Form (kids 10 and up)
Behavior Appointments:
The doctors may have assigned questionnaires through the Valley Pediatrics Patient Portal. Please check the portal and fill out the requested surveys. You do not have to complete the forms below if you have already completed them through the portal.
Flu Clinic Visits:
Our flu clinics occur in the Fall, once we have received our flu vaccine. We will vaccinate patients over 2 years old. No visit is necessary. We ask that you bring a completed Flu Signature Sheet for each child. We have both injectable and nasal (FluMist) available. Most patients are out in less than 10 minutes! Stickers included. You can self-schedule through the patient portal.
COVID VACCINE:
