For parents-to-be who would like a prenatal visit and introduction, please complete this short questionnaire to help us get to know you.
Please complete this form to have your child's medical records released to our office, from your child's previous health care provider.
If you are a new patient, we will ask you to read and sign a Privacy Notice. To save you time in the office, please read and sign this document. Bring only the signed last page with you to your appointment.
This form contains a representative list of potential fees and charges you may incur, so you are better informed at the time of service, and prior to the arrival of a billing statement.
For all new patients. Please bring the completed form to your child's first visit at our office
If you are new to PHCA and your child is age 6 months or older please bring this completed form to your child's first visit at our office.
Please complete this form to notify us as to the individuals who may bring your child to the office for treatment. Without this form, we will be unable able to deliver medical service to your child if he or she is accompanied by someone other than the listed parent(s)/legal guardian.
This form must be completed by the parent or guardian who will be present for office visits. It covers our financial responsibility policies and notice of privacy practices.
A registration form is required each year to obtain current information for patients and parents.