Patient Forms

Thank you for selecting After Hours Pediatrics for your pediatric urgent care.

You may pre-register by downloading, printing, and completing the intake form below. Please be sure to bring it with you to your visit. Completing the form prior to your visit will help speed up the patient registration process.

Downloadable Forms:

• Intake (Registration) Form
• Authorization for Minor's Medical Treatment
• Authorization to Release Healthcare Information
• Notice of Privacy Practices

Please Note: It may take a few minutes to load the forms if you are using a slow internet connection. If you are unable to view the forms, you may need to download Adobe Acrobat for free by clicking on the icon below.