Release and Authorization Forms Third Party Authorization Form Use this form to authorize treatment if someone other than a parent or guardian is bringing in a child for a visit.
Medical Records Request Form Use this form to request your child's medical records from another medical practice. Note: If you have not been seen in our office, and you are interested in transferring your child or children's medical records to our office, please call our office and ask for Cheryl Jenkins, the Business Manager, prior to transferring records.
Disclosure Form Use this form to authorize us to share your child's medical information with a third party, such as a school or a government agency.
The material provided on this website is for informational purposes only. If you need specific medical advice, please contact the office for an appointment.
