Resources & Forms
settingsPrimary Pediatrics encourages patients to print and complete forms before your appointment. This can reduce your wait time when you arrive at our office. When you call to schedule an appointment, we will inform you which forms you should complete before your visit.
Coming soon: The ability to submit your forms on the Healow app! We’re not quite there yet, but soon you’ll be able to find the form you need, fill it out, and send it right to us, no printer needed.
settingsOur Medical Forms
Patient Demographics & History
Authorization for Release of Health Information From Primary Pediatrics
9 Month Questionnaire
Authorization for Release of Health Information To Primary Pediatrics
18 Month Questionnaire
Modified Checklist for Autism in Toddlers (M-CHAT-R/F ™)
30 Month Questionnaire
Immunization Form
2 Year Questionnaire
Accepted Insurance Plans
12-Year-and-Up Questionnaire
Tuberculosis Risk Assessment Form
PHQ-2 Depression Scale
DPH Lead Questionnaire
Notice of Privacy Practices
Confidential Electronic Communications Acknowledgement
NP/PA Clinical Rotation Preceptor Request Form
Acknowledgement of Privacy Practices
HIPAA Authorization & Consent Form
Interoffice Records Transfer
Website & Social Media Release Form
Stress Response Packet
Insurance Info
Explore the insurance plans we accept. Don’t see yours listed? Call our office for support.
View Insurance InfoPatient Portal
Primary Pediatrics is proud to offer an online patient portal allowing you to request appointments, view medical records and test results, and pay medical bills online. You can also make changes to your current appointments through the online portal.
Log In