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Need Some Help?
Please don’t hesitate to call us or make an appointment to be seen. |
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Patient Information
To facilitate your initial visit with us, please print & complete one of the first two new patient packets depending on whether or not your child is a newborn (age less than 30 days).
Please bring the completed forms with you. In addition, if your child has already received any immunizations, please bring your child’s immunization (shot) record. We look forward to seeing you!
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Includes a Patient Info Form, Health Info Privacy Policy, Financial Policy, Pediatric History Form & a Newborn Form |
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Includes a Patient Info Form, Health Info Privacy Policy, Financial Policy, Pediatric History Form & a Medical Record Release |
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To request your child’s previous medical records from a physician, group, clinic, or hospital be sent to Hometown Pediatrics |
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To request your child’s medical records from Hometown Pediatrics be sent to an alternate physician, group, or health agency |
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The forms on this Web site are in Adobe PDF format, which requires the Adobe Reader. |
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