Forms and Policies

The patient forms are PDF files, you may need to download Adobe Acrobat Reader to view them.

PLEASE BRING THE FOLLOWING INFORMATION TO EVERY APPOINTMENT

• Insurance card
• Co pay if required
• Identification (for parent/guardian)

Schedule of visits including vaccines

Financial policy

HIPPA Privacy Act

Office policies

Communication Authorization

Policy Information

Authorization and acknowledgement form

This form is signed yearly, usually at your child's physical stating that you understand the policies at Town Center Pediatrics. 

Download form to sign

Medical Record Release Form

Please fill out completely and allow 2-3 weeks for processing.

Download form to sign