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TWO (2) required forms
are in .PDF files
that you can download, read,
type into, and print by using the FREE Adobe Acrobat Reader
that must first be installed on your computer.
Our New Patient Forms will download
after you click on each of the New Patient Forms links below. Each is in
a "fillable" .PDF file that cannot be submitted electronically
from this Web site.
Instead, you must
print out each of the forms and bring them with you on
your first visit to our office, but please
continue reading this page.
●When
viewing a downloaded form, if data entry fields where you can type
necessary information are not
highlighted, there may be
a check box in the upper right hand
corner of the form's window with the words
Highlight fields that you can click to cause the data entry fields to
become highlighted.
●After
you click on and try to type into the first
fillable data entry field, there will be a
delay of 30 seconds until Adobe Reader
displays a message box - close the message
box and you
can proceed to enter data.
●Whenever
a Yes or No choice is presented,
CLICK on either
Yes or No, your choice will be marked, and it will
print as circled after you print that form!
*If you don't have the current FREE
Adobe Acrobat Reader installed,
CLICK the Get Adobe Reader®
stamp below:
Below are links to the New
Patient Forms - please CLICK on each of the links for the TWO (2)
REQUIRED forms you must complete:
1.
Child's Initial History Questionnaire - (one for each child)
2.
Patient Information & Policies Acknowledgement Form
A.
Transfer & Copy of Records
TO CCW-REQUEST FOR RELEASE OF MEDICAL INFORMATION - TO CCW
from another medical office
B.
Transfer
&
Copy of Records FROM CCW-REQUEST FOR RELEASE OF MEDICAL INFORMATION - FROM CCW to
another medical office- with Fees
Reminder
to New
Patients:
To shorten the length of your office visit please complete:
#1
Child's Initial History Questionnaire
#2
Patient Information & Policies
Acknowledgement Form
and bring
all required forms with you.
The staff at Children's Clinic thanks you! |
