Information For New Patients
 
  Welcome to Shoreline Pediatrics. We are happy and grateful that you are entrusting the care of your child to us. Below are patient registration forms for new patients. You should download, print and complete the forms that are needed for your child. If you have more than one child who will be coming to Shoreline Pediatrics, you will need to complete a set of forms for each child. Sorry about that.  Please note, these forms are to be filled out by the parent (biological, adoptive, or  foster) or legal guardian.  A parent (biological, adoptive, or foster) or legal guardian must accompany the child/children for the initial visit.  The parent or legal guardian completing the paper work can designate other individuals (step-parent, grandparent, etc.) consent to bring the child in for future visits by completing the "Consent for Care" form. 

If you are bringing a newborn or child under 6 months of age please complete these two sets of form.
Patient Information
Newborn Medical Information
and if coming form another physician office the Transfer of Medical Information

If you are bringing a child over 6 months of age
please complete these two sets of form.
Patient Information
Pediatric Medical Information
and if coming form another physician office the Transfer of Medical Information

For All New patients
In addition to the forms, a parent (biological, adoptive, or foster) or legal guardian must be with the child the first checkup. Picture IDs of the parent (biological, adoptive or foster) or legal guardian are required along with current insurance information. If there are any child custody or guardianship issues, we will also need to see the legal documents and make copies.



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