We are happy to provide our office forms that may be filled out Online and securely emailed to our office (HIPAA secure), or may be downloaded on your home computer. Please either fill out the forms online and submit them to us, or print and complete the forms below and bring them with you to your child's first appointment. Questions about which forms you need? Please call our office and our courteous staff will assist you in preparing for your child's first visit.
This is a form to release medical records FROM Kids First Pediatrics
Please be aware that there is a $25 fee* for copies of medical records from Kids First Pediatrics * This fee is waived if only immunization records are requested
Please fill the form out and submit it (Online) or fax it (printable PDF) to our office at (815) 609-8111 if someone other than the parent or guardian will bring the child into the office
Please note that a parent or guardian must be present for immunizations to be given. We cannot accept this form for well-child visits.
