Forms
Filling out forms before a visit can save time on an office visit. Feel free to print these forms, read them carefully, complete them and bring them with you when you come to the Clinic.
Patient Bill of Rights and Responsibilites
TCC Financial Policy
Notification and Opt-out Statement & Form
Notificación y Forma de Opción de Exclusión
Patient Registration
Health History Form Over One Month Spanish
Health History Form Over One Month
Health History Form Under One Month Spanish
Health History Form Under One Month
Generic Sports Form
SPORTS FORM INSTRUCTIONS: - Complete part one. If there are any “yes” answers please include a brief written explanation. - In order for the MD to sign part 2, part 1 must be completed for the MD to review. - Include the following information on the sports form: o Pt’s name and date of birth o Phone number and fax number (if applicable) o When the form is due o How you would like us to return the completed form. Options include: fax, mail, pick up at front desk, or email (through our patient portal) Please allow 2-3 days for us to complete the form. IMPORTANT!!! If the patient’s most recent physical was over 2 years ago we CANNOT sign the form.
Medical Release Form
Authorization for The Children’s Clinic to Release Medical Information
Iron Rich Foods Spanish
Calcium Containing Foods Spanish
Feeding Solid Foods Spanish
Iron Rich Foods
Fever Handout Spanish
Calcium Containing Foods
Fever Handout
Feeding Solid Foods
Receiving Medical Information
Authorization for The Children’s Clinic to Receive Medical Information
Acetaminophen/Ibuprofen Dosing Chart
Permission To Treat
Please Bring this form in on your first visit with us in order to avoid a longer wait time in the office