Office

Patient Forms

Prior to your appointment, please review and complete the New Patient Registration Packet in its entirety for each child that will be joining the practice. You may save as a PDF and upload to email@wppc.pcc.com

If you already have MyKids chart patient portal you may upload the forms here.

Prior medical records and immunization records are required for children transferring care to us. We highly recommend you have the medical records directly sent to you and then submit to us electronically or in person prior to the appointment. Appointments will be scheduled based on the completion of this. This ensures we can review your child's chart with adequate time.

Newborn parents are requested to bring the hospital discharge paperwork. We will scan the records at your first appointment with your Pediatrician.

Key Forms

Download PDF
Format
Flu COVID Questionnaire*
Patient Form*
18 and Older - Patient Form*
Financial Policy Form*
Patient Registration for Flu*
Vaccine Consent Form in Absence of Parent/Guardian*
Release of Records Form*
Lactation/Edinburgh Information Sheet*
Notice of Privacy Practices*

*You must have an Acrobat Reader to view the Acrobat files. If you don't already have Adobe Acrobat, you can download the Acrobat Reader Free.