Welcome new patients to our family!
The following are our policies for you to review and the forms we will need you to fill out prior to your first visit with us. The forms here are in PDF format. If you do not have Adobe Acrobat Reader installed, you can download it by clicking on the image at the bottom of this page.
Policies to be reviewed
- Patient Centered Medical Home – Welcome letter explaining what a patient centered medical home is and how it helps us to provide whole patient care to you and your family
- Patient Portal – Letter explaining the benefits of our patient portal and how to access the portal.
- Patient Privacy Practices – This is our privacy policy explaining how your health information will be used and how we plan to protect your information from unauthorized access.
- Patients’ Bill of Rights – This policy outlines your rights as a patient.
- Patient Responsibilities – This policy explains the responsibilities that you have as a patient of Premier Care Pediatrics.
Forms to be filled out
- New Patient Information – This is the most important form for us to begin creating a medical record for your child. It includes all pertinent demographic information.
- Medical Records Release to Us – This form is for you to fill out and sign, requesting your previous pediatrician to send medical records to us. This will allow us to provide the best possible continuation of care for your child.
- Authorization to Provide Medical Care – This form is designed to allow you to authorize additional family members or friend to consent for treatment of your child, should you wish to do so.
- Parent Acceptance of Policies – This form must be signed by the patient or legal guardian accepting the above policies, financial policies, and authorizing consent for Premier Care Pediatrics to provide medical care.
All New Patient Forms can be viewed as a single PDF file here.
