Kids Creek Children's Clinic Patient Forms

For your convenience, the following forms are available to print and complete prior to an appointment in our office. Please give your completed forms to our staff member at the check-in desk upon arrival in the office.

New patient/newborn forms:
Family Information Form
Pediatric Health History

Change of address/phone number/ custody/ emergency contacts:
Family Information Form

Adolescent Physical Questionnaires
Adolescent Parent Questionnaire
RAAPS: Middle School Questionnaire
RAAPS: High School Questionnaire

Information Request
Authorization for Release of Information
Consent to Treat