OC Pediatrics Medical Group Inc.
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PATIENT FORMS

 Please print out the correct forms below, fill them out, and bring them in with you on your appointment day!!

 Required for all patients:


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Demographic & History
Authorization to release healthcare information
Notice of Privacy
Patient Partnership.pdf

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Please print out forms below according to your child's age

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Staying_Healthy_Assessment_0-6_Months.pdf
Staying_Healthy_Assessment_7-12_Months.pdf
Staying_Healthy_Assessment_1-2_Years.pdf
Staying_Healthy_Assessment_3-4_Years.pdf
Staying_Healthy_Assessment_5-8_Years.pdf
Staying_Healthy_Assessment_9-11_Years.pdf
Staying_Healthy_Assessment_12-17_Years.pdf
Staying_Healthy_Assessment_18 and older.pdf
What_does_your_child_eat_0-8yr.pdf
What_Does_Your_Child_Eat_9-18yr.pdf

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Please fill out the form below only if your child will be receiving vaccines during their visit.


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Vaccine_Questionnaire_for_Children.pdf
Vaccine_Questionnaire_for_Adolecent.pdf

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Please fill out the form below only if your child will be receiving the FLU vaccine during their visit.


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Flu vaccine consent.pdf

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