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- The Next Step in Quality Pediatric Health Care
New Patients
Please download the Registration Package which includes Demographics, Insurance info, and Financial policy acknowledgement. Please fill it out before arriving to our office.
- Registration Package
- Demographic Form
- Insurance Information Form
- Financial policy
- Annual Demographics/Financial Consent
- HIPAA Notice of Privacy Practices
- Record Release – to send records to another facility
- Record Request – to obtain records from another facility
- Parent Portal Access Request
- COVID-19 Vaccine Consent
- Vanderbilt Assessment Form
Vaccines Information Sheets
2, 4, 6 Months
Pentacel, Prevnar, Rotateq
1, 9 Months
Hepatitis B
12 Months
MMR (Measles, Mumps, and Rubella), Varicella (Chickenpox), Prevnar,
15 Months
Pentacel
18 Months, 2 Years
Hepatitis A
Vaccines Information Sheets
4 Years
MMR (Measles, Mumps, and Rubella), Varicella (Chickenpox), Quadracel (DTap/Polio)
11 Years
Tdap, Meningitis, HPV
12 Years
HPV
16 Years
Meningitis
17 or 18 Years
Trumenba (MenB)