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Forms for New Patients
Please print and complete a new patient information form before arriving at your first appointment.
Please obtain health records and vaccine information from previous health care providers before your first appointment.
If you need a form completed by Carmel Pediatrics for sports, camp, daycare, etc. please print and complete the authorization below.
For your convenience:
Forms for Release of Records
When you must leave our practice please complete the following form to transfer your child’s care to another physician.
Child Care Authorization
If someone other than a biological parent who is over the age of 18 (includes siblings) brings a child into the office for care, we must have authorization from a biological parent. There are a few different ways to do so, and it must be in writing:
- Biological parent lists these individuals on the patient demographic form that is updated annually;
- Write a letter giving authorization for a particular person;
- Or, CLICK HERE fill out a form and then fax/mail back to us.