KIDS DOC registration

We will make every effort to complete your child's registration before you arrrive for the appointment. However, to do that we may need to contact you by telephone if you do not provide all the requested information. If you prefer, you may download a printable version of the form and submit it by mail or fax.

Please complete registration at least 24 hours prior to the scheduled appointment to allow time for processing.

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Here's what you'll need…

• Child's background information
  (Including place and date of birth)
• Primary care physician and phone number
  (The doctor you visit for immunization, school physicals, etc.)
• Insurance coverage details
  (Usually found on your insurance card or recent paperwork)
• When your child's appointment is scheduled
• Your contact information
• Emergency contact
• Parent or guardian contact information

Begin registration »