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Pediatric AssociatesWant to Chat? 816.561.8100

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Pediatric Associates
New Parents
Transferring Families
Established Families
Informed and Connected

Paperwork

FOR YOUR CONVENIENCE PLEASE DOWNLOAD AND PRINT APPROPRIATE FORMS BELOW:
Family Registration (one per family) - PDFPDF icon

Patient Medical History (one per child) - PDF PDF icon

Information Release (one per child) - Word doc Word icon or PDF PDF icon

Privacy Policy - PDF PDF icon

Please bring completed forms with you to your appointment.
You can fax completed forms in advance to:


(816) 561-8154 (Plaza Office)
(816) 554-3607 (Lee’s Summit Office)

Pediatric Associates