FORMS
Most health information for your child can be found on your After Visit Summary on your Child's MyChart account.
Request school entry forms, sports clearance forms and camp forms at your child's annual well visit for no fee.
Other forms can be sent to us through MyChart or brought directly to the office. Please note that Urgent Forms (requested turnaround in 48 business hours or less) will now incur a fee of $25. Routine forms will still have the basic fee of $10.
Request school entry forms, sports clearance forms and camp forms at your child's annual well visit for no fee.
Other forms can be sent to us through MyChart or brought directly to the office. Please note that Urgent Forms (requested turnaround in 48 business hours or less) will now incur a fee of $25. Routine forms will still have the basic fee of $10.
EAST BAY PEDIATRICS FORMS
RELEASE OF PATIENT INFORMATION
Complete, sign and send this form to any other health care provider who may have medical records that would be helpful to your doctor at East Bay Pediatrics. Note: It may take your previous doctor 2-6 weeks to send us the appropriate information. Please request records as early as possible.
Complete this form if you would like East Bay Pediatrics to release medical information to another provider or if you'd like to request a copy of your child's medical records.
Complete, sign and send this form to any other health care provider who may have medical records that would be helpful to your doctor at East Bay Pediatrics. Note: It may take your previous doctor 2-6 weeks to send us the appropriate information. Please request records as early as possible.
Complete this form if you would like East Bay Pediatrics to release medical information to another provider or if you'd like to request a copy of your child's medical records.
| release of information form |
18+ CONSENT FORM
This form allows us to speak with a parent or guardian of our patients who are 18 years old and over.
This form allows us to speak with a parent or guardian of our patients who are 18 years old and over.
| Consent Form (18 years old and over) |
FOR NEW PATIENTS
NEW PATIENT/PARENT PACKET
New families transferring from another practice please start by completing the new patient intake form. Parents expecting a baby please complete the new parent intake form. Once our coordinators receive the form and create your account they will call you to schedule your appointments and/or prenatal meet & greet.
New families transferring from another practice please start by completing the new patient intake form. Parents expecting a baby please complete the new parent intake form. Once our coordinators receive the form and create your account they will call you to schedule your appointments and/or prenatal meet & greet.
