Patients may be asked to complete several forms prior to their visit, which may include a New Patient Packet and Acknowledgment of Receipt of Privacy Practices. Please find these forms below. As these forms are password-protected, you will be provided a password to access the forms by our office secretary. To access the forms, please click on the title of the respective form or  CLICK HERE . Should you have any difficulties, please do not hesitate to contact us at 407.765.KIDS and we will be happy to assist you.

New Patient form

All new patients are asked to download and complete the "New Patient Packet" prior to their first appointment. This includes Informed Consent & Office Policies; HIPAA Privacy Practices; and a Background and Medical History Form. 

Registration form 

All patients are provided a copy of this Privacy Policy notice. Please read it carefully to understand your privacy rights and responsibilities as well as those of your provider.

School form

If you would like the office to obtain prior medical records, or to disclose such records, you will be asked to complete this form in full. One form must be completed for each entity or organization that records will be obtained from or disclosed to.