Other Forms You May Need as Patients
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.
-Walk-In Clinic Form (Complete when bringing sick child during walk-in clinic hours)
-Medical Records Request (To send from prior provider to Ponderosa Pediatrics)
-Medical Records Request (To send from Ponderosa Pediatrics to new provider)
-Patient Consent Form (To authorize procedures such as circumcisions)
-Power of Attorney Form (To allow a non-parent/guardian medical or other parental decision making authority for a period of up to six months.)
-Revocation of Power of Attorney Form
-Ponderosa Pediatrics Employment Application
-Headache Questionnaire (Complete prior to coming in for appointment for headaches.)
-Life Care Planning Packet From AZ Attorney General. The packet includes the following:
-Greetings from the Attorney General
-General Information about Arizona laws related to future incapacity
-Frequently Asked Questions about Life Care Planning (Advance Directives)
-Life Care Planning forms with instructions
