Welcome to DLC Pediatrics, if you are transferring to our office or you want to update patient information, check the forms below. Click to download:
New Patient Forms:
- Registration
- Privacy Notice (HIPPA)
- Notice of Patient Privacy Practice Policy
- Financial Policy Sheet
- Investment Letter
- Patient Portal Consent
- Physician Assistant Disclosure
- Preventative Co-pays
Transfer or Request Records Forms:
- Medical Record Release Form (From Clinic to Clinic)
- Medical Record Release Form (From Clinic to Patient)
Please fill out the forms and return them to the office.
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