New Patient Paperwork
Please complete the forms for children prior to their first appointment. Forms are grouped by age; and all forms in each age group need to be completed. These forms are in a fillable PDF format allowing you to complete them on the computer and print them on your home printer. They cannot be saved with Acrobat Reader. You may print the forms and fill them out by hand.
Parents who come in with these forms already completed generally are able to reduce their time in the waiting room and in the office. This also allows you to find information that may not be readily available if you were to complete them in office. In addition, the new patient checklist below will help you organize for the appointment.
New Patient Checklist:
- Paperwork and forms completed and signed where indicated. Please bring them with you!
- Parent drivers license and/or other picture identification.
- Patient current insurance card(s) for a plan accepted by Ponderosa Pediatrics (click here for list).
- Immunization (shot) records.
- Be ready to pay any insurance required copayments at check in.
- If the patient does not have insurance, payment in full is expected at the completion of the visit. Patients paying in full at the time of visit receive a prompt pay discount.
Age Birth to Four Years (click form to download):
Age Five to 18 Years (click form to download):
