To expedite your first appointment, please arrive a few minutes early to
complete registration forms so that we have all the necessary information to
treat your child. You may also download and print the forms from this website,
fill them out ahead of time, and bring them with you to the first
appointment.
You can also email them to reception@surfsidepeds.com.
New patient forms
- Patient Information Form
- Financial Policies
- HIPAA Notice of Privacy
- Transfer of Medical Records Form (releasing records TO our office)
Newborn forms
Other forms
- Transfer of Medical Records Form (releasing records FROM our office)
- Consent for exchange of mental health information (from one of our providers to an outside mental health therapist)
- 18yr consent form (grant permission to release medical information to your parent)
- Consent for treatment of a minor (grants permission for someone besides parents to bring patient in)
In order to view or print these forms you will need Adobe Acrobat Reader installed. Click here to download it.