Forms

Welcome to Quincy Pediatrics! Prior to your child's first appointment we suggest the following:

• Please review our forms and policies prior to arriving for your first appointment.
• Print and complete the forms below, they must be signed by responsible parent or guardian.
• Bring these forms with you when you come in for your first appointment.
• Complete these forms for each child that is new to our office.
• Be sure to sign all forms.
• Bring with you proof of insurance.
• Photo ID or drivers license.
• Be sure your childs medical records have arrived and in your child's QPA record prior to his/her appointment.

• Patient Registration
• Financial Policy
• Social History
• Vaccines For Children Program
• Privacy Policy
• Acknowledgment of Receipt of Privacy Practices
• Family Medical History
• Well Child Exam Schedule
• Ethnicity Form
• Pateint Gateway Form

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