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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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7pgs includes forms: Patient Info, Health Info Privacy Policy, Financial Policy, Pediatric History, Newborn & ImmTrac Reg'n |
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7pgs includes: Patient Info, Health Info Privacy, Financial Policy, Pediatric History, Med Record Release & ImmTrac Reg'n |
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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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For the parents or legal guardians wishing to grant permission for another adult to make health care decisions for their minor(s) |
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The forms on this Web site are in Adobe PDF format, which requires the Adobe Reader. |
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