Please fill out forms before your visit (save time and make your visit hassle free).   Find the appropriate form, fill them out on your computer and print them out. They can be faxed (383-3255), mailed or turned in at the time of your appointment.

The following forms that are in PDF format, can be filled out on your computer. Or you can print them first and then fill them out on paper. You cannot save the forms after you have filled them out.

• Registration Form 2010 (pdf version – preferred)
• Registration Form 2010 (word version)

• Registration Update Form 2010 (pdf version – preferred)
• Registration Update Form 2010 (word version)

     Parent Forms (for parents who receive vaccines in our office):

• Parent registration for vaccines
• Parent registration form.doc (for emailing through housedoc.us)

Well Visit Forms - If you have NOT been in the office in the last 6 months, please ALSO fill out the Periodic 6 Month Registration Form noted above.  Four Seasons Pediatrics in compliance with Federal Law, known as the Red Flag Rules, requires this form to be filled out every 6 months.  In addition, the rules state that we identify you with a photo ID and your current insurance card at each visit to our office.  These rules were enacted to prevent identity theft and are for your protection.

The vaccine information statements can now be viewed online before your appointment.  Click Here to review online – GO GREEN AND REVIEW TO SAVE PAPER.

• First Visit Thru Two Month Visit
• Four Month Thru Six Month Visit
• Nine Month Thru Fifteen Month Visit
• Eighteen Month Thru Two and One-Half Year Visit
• Three Year Visit
• Four Year Thru Five Year Visit
• Six Year Thru Eleven Year Visit
• Seven Year Thru Seventeen Year Visit
• Eighteen Years and Older Visit

Special Forms:

• Boy Scouts BSA Annual Health and Medical Record
• Pop Warner Physical Form

Flu Vaccine Screening Forms:  Fill out these forms if you are coming in for a flu vaccine.  One form for each person vaccinated:

• Seasonal Flu Vaccine Screening Questionnaire. 

ADHD Forms:

• ADHD Parent Feedback Form - Parents fill out this form.  Email back to us through Housedoc (or drop off BEFORE your appointment).
• ADHD School Fall Feedback Form - Parents can email this form to the school teacher.  This form is used for teachers who are new to your child (typically in the fall).  Once completed email back to us through Housedoc (or drop off BEFORE your appointment).
• ADHD School Spring Feedback Form - Parents can email this form to the school teacher.  This form is used for teachers who have rated your child before (typically in the spring).  Once completed email back to us through Housedoc (or drop off BEFORE your appointment).
• ADHD Adolescent Self Form - Adolescents (typically in High School) may find it difficult to find teacher feedback.  Instead they can choose to rate themselves.  Once completed email back to us through Housedoc (or drop off BEFORE your appointment).

Adobe Reader (or Acrobat) is required to view these pdf forms. Click here to download Adobe Reader for free.

Microsoft Word or Open Office is required to view these word documents.  Click here to download Open Office for free.