Consent Form for Use and Disclosure of PHI

Notice of Privacy Practices (English)

Notice of Privacy Practices (Spanish)

Authorization to Release Medical Records to CPA

Authorization to Release Medical Records from CPA

Annual Health Check Forms

You may print and complete all the forms located within the link associated with your child/children’s age before your scheduled appointment. Please do not complete the forms any earlier than 2-3 days before your appointment date. Bring all completed forms with you and give to the receptionist upon arrival. If you have any questions regarding these forms, please wait to discuss them with the provider or nurse during your health check.

Newborn Health Check

1 Month Health Check

6 Month Health Check

9 Month Health Check

12 Month Health Check

15 Month Health Check

18 Month Health Check

2 Year Health Check

3 Year Health Check

4-6 Year Health Check

7 Year Health Check

8 Year Health Check

9 Year Health Check

10 Year Health Check

11-20 Year and Older Health Check

Sibley Cardiac Risk Questionnaire