Office Forms

2018 New Patient Forms
These forms are needed for your first visit to Pediatric Wizards. Please fill them out prior to your first visit. Also, make sure to print out the patient information form found under the Patient Information Tab. If you are transferring from another practice, please click on and print out the medical records release form. Kindly fill it out and send it to their office so we may have your child's records prior to their first visit to our

New Patient Vaccination Policy

2018 Established Patient Registration
Print these, fill them out and bring them in when needed.

Please fill these forms out prior to your child's 18 month & 2 year well visit in our office.

Prenatal Questionnaire
If you are seeing Pediatric Wizards for the first time prior to your due date, please download and fill out this questionnaire.

Newborn Feeding Questionnaire - 1 week visit
A questionnaire used to determine if you are experiencing feeding issues with a newborn or infant. Please fill this 24 hours prior to your 1 week follow-up visit in our office.

Medical Records Release Request
To request a copy of your child(ren)'s medical record, please fill out the following form and fax/mail to our office. Medical Records may take up to 14 business days to process once the signed request is received in our office.

Designee Authorization Form
If someone else needs to bring in your child for a visit, please have this form filled out and with them.

ADHD Parent Evaluation and Follow Up Forms
Conners Parent Form
These forms include parent evaulation and follow up forms for ADHD assesments and medication monitoring.

ADHD Teacher Evaluation and Follow Up Forms
Conners Teacher Form
These forms include teacher evaulation and follow up forms for ADHD assesments.

Patient Information Form
Please fill out this form, print it, and then bring it with you to your next appointment.

Notice of Privacy Practices. This is for your records only. You do NOT need to print this for our office.