Four Seasons Pediatrics

Flash header display failed. Please install Flash and come back.

Forms

Please fill out forms before your visit.   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 are in PDF format and 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 Forms

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.

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

Adobe Reader is required to view these forms. Click here to download Adobe Reader for free.