Foundation Pediatrics

Forms

You can save time on the day of your appointment by printing the following forms, if needed, and bring them with you to your appointment. The form file is viewable with Adobe Acrobat Reader.

 

CDC Vaccine Information Statements - Click here for more information on vaccines.

 

Parental Consent Form -  Please fill out the attached form if you grant medical care of your child to someone other than the legal guardian in their absence.

 

Patient Registration Form - Please print and complete this form and bring it to your first appointment.

 

Release of Records - Please complete this form if you are a new patient and have not yet transferred your records to our practice. The completed record release form can be mailed, faxed, or hand carried to our office or to your previous pediatrician.

 

Well Child Exam/Immunization Schedule - Click here for a complete listing of the recommended schedule for well child exams and vaccines.