New Patient Forms

Once you've selected a Valley Children's pediatrician, be sure to bring your insurance card, immunization record, and the completed following forms to your first visit:

Patient Registration Form | En Español
Patient Health Information | En Español
General Consent to Treatment | En Español
Authorization for and Consent to Surgery or Procedures | En Español
Financial Policy | En Español
Third Party Consent Authorization | En Español
Acknowledgement of Notice of Privacy | En Español
Caregiver Affidavit | En Español

Authorization to Use and/or Disclose Health Information:

• Dakota Pediatrics | En Español
• Fresno Children's Pediatrics | En Español
• Magnolia Pediatrics | En Español
• Olivewood Pediatrics | En Español
• San Dimas Pediatrics | En Español
• Sky Park Pediatrics | En Español
• Stockdale Pediatrics | En Español