English Forms and Spanish Forms for Pediatrics of Queen Creek, Coolidge Pediatrics and Main Street Pediatrics
When scheduling your first appointment at our office, you will be required to fill out patient forms. To expedite this process we offer the opportunity for you to download, print, and fill out the required forms by opening the link below. Please be sure to bring these forms, your child’s insurance card/information, and your child’s immunization record to our office for their first appointment.
English Forms
- Consent for Treatment
- CHECKLIST FOR NEW APPT
- New Patient Packet
- Records Request
- Notice of Health Information Practices
- Parenting Policy
- Notice of Privacy Practices
- Well Check Sick Visit
- How to make a fire plan
- SDOH Form 1
- SDOH Form 2
- Water Safety
- Water Safety ABC's
- Updated Forms
- Physical Form
- Test Physical Form
