Patient Forms

PCG provides an array of resources to our patients. These include a robust patient portal where you can access your health records, view lab results and pay a bill in the comfort of your home via web or mobile app. You can also download new patient forms and quickly access Healthy Children, a respected resource for parents from the American Academy of Pediatrics (AAP).​

Pediatric Care Group prides itself on being able to provide high quality medical care to its patients. In an effort to be more efficient and maximize patient satisfaction during office visits, PCG requests that patients fill out appropriate forms prior to their scheduled visit.

Click Here to view PCG’s Notice of Privacy Practices

PLEASE PRINT AND FILL OUT FORMS PRIOR TO VISIT
 *Please Remember to Bring Completed Forms With You to Your Scheduled Appointment*
Instructions:
 New Patients Must Complete and Sign New Patient Visit Forms.

New Patients Being Seen for a Wellness Visit Must Complete and Sign New Patient Visit Forms and Wellness Visit Forms.

Patient Over 18 Years Old:
 Patients who are over 18 years old may give PCG physicians and medical staff the authorization to speak with parents, guardians or other individuals regarding their healthcare.

Click Here To Download The 18 Year Old Medical Consent Form

New Patient Forms

New Patient Registration
Initial History Questionnaire
Family History Questionnaire
Acknowledgement of Privacy Practices and Policies
Acknowledgement of Appointment
Cancellation/No Show Policies
Medical Release Form
Consent By Proxy Form
Assignment of Benefits Form
Download Here

Wellness Visit Forms
Asthma & ADHD Forms:
Transition Policy for Patients Transferring to Adult Medical Practice