Online Forms

We are honored that you have chosen Model City Pediatrics to care for your family!
 

In addition to the forms below, please provide photo ID of the parents, the insurance card, immunization records, and all medications, both over the counter and prescription, upon arrival at first visit.

We are happy to provide our office forms for convenient download on your home computer. Please print and complete the forms below, and bring them with you to your child’s first appointment.

In order to view or print these forms you will need Adobe Acrobat Reader installed. Click here to download it. 

Forms and School Excuses
*School excuses will not be given for the days when the child is out of school and is not seen in our office.

Our practice charges for additional paperwork outside of the completion of the medical records. The following fees apply and are subject to change without notice.

Copy medical records – $25.00
Blue Forms – $5.00

If you request a Blue Form on the day the vaccines are given to your child we will not charge you for the Blue Form.