In order to help our staff serve you better, we ask that you download, print and complete the list below prior to your appointment.
- Financial Policy (Please print, sign and keep a copy for your records. An updated signature page is required annually.)
- Office.Phone.Email.Mail Policy (Please print, sign and keep a copy for your records. An updated signature page is required annually.)
- Patient Demographic Patient Information Sheet (Each year we need you to fill out a new sheet to keep in your chart.)
- Consent to Treat Minors
- Heritage Pediatrics Privacy Practices (Please read and keep for a copy for your records.)
- New Patient Medical Intake (Please print, fill out and bring to your first visit with the doctor.)
- New Patient Consult Paperwork (Please print, fill out and bring to your first visit with the doctor.)
- Medical Records Release Form (New Patients)
If you are seeking an ADHD evaluation, our physicians will need the following evaluation forms completed so that they may review them with you during your child’s appointment.
- Parent ADHD Evaluation Form
- Flow Sheet for Parents when Evaluating Your Child for ADHD
- Teacher ADHD Evaluation – teacher cover letter, teacher evaluation form
