Parent Forms & Office Policies
You may download and print any of our forms listed below before coming to our office. This will get you out of the waiting room and in to see the doctor a lot quicker! You may either bring them with you to the first visit, or if you wish, fax them to us before your appointment.
New To The Practice
Please be familiar with our policies:
- Office Policies
- Billing and Insurance Policies
- Cancellation Policy
- Payment Policies
- Daycare/School Forms Policy
- Divorced/Separated Parents Policy
- Notice of Nondiscrimination
If you are new to Legacy Pediatrics, please print and bring these forms in to the office when you visit.
Administrative Forms
- Patient Authorization (For Patients 18 Years & Older)
- Patient Demographic Form
- Family Medical History Questionnaire
- Patient Portal Consent Form
- Permission Regarding Communications / HIPAA Form
- Notice Of Privacy Practices
- Request for Release of Medical Records
- Authorization to Release Medical Records
- Adult Vaccine Consent Form