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Pediatric and Young Adult Medicine

Pediatric and Young Adult Medicine

Welcome to our Tradition of Caring

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Pediatric & Young Adult Medicine

Forms

Save time! Here are several Medical Forms for you to fill out before your visit.

In order to provide optimum healthcare, we ask that you complete medical paperwork before your visit. Completing these forms before your visit saves time at the Center and allows you privacy and access to information.

Please download, print single sided and fill out the forms below and bring them with you to your visit. Fill out the forms in black or blue ink only and check or cross the boxes off individually.

To view these files you will need to have Adobe’s Acrobat Reader.
Its a free download and is available for both the Mac and Windows.

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Patient Portal Young Adult Full Proxy Access

1 file(s) 85.84 KB
Download
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Patient Portal Proxy Access

1 file(s) 85.29 KB
Download
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iHealth Notice of Privacy Practices

1 file(s) 194.11 KB
Download
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iHealth Patient Portal Registration Form

1 file(s) 4.00 KB
Download
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Authorization for release of Medical Information

1 file(s) 194.11 KB
Download
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Patient ADHD Refill Instructions

1 file(s) 87.42 KB
Download
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Wart Treatment

1 file(s) 158.93 KB
Download
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Wart Consent

1 file(s) 55.91 KB
Download
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Flu Screening Questionnaire

1 file(s) 76.90 KB
Download
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Asthma Control Test for Children 4 to 11 years

1 file(s) 383.38 KB
Download
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Asthma Control Test for Patients 12 Years or Older

1 file(s) 161.24 KB
Download
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Bright Futures Previsit Questionnaire

1 file(s) 342.40 KB
Download

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    For appointments only please call 651-256-6714. To speak with a provider & for all other purposes please call 651-227-7806 (MN).

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