Filling out forms before a visit can save time on an office visit. Feel free to print these forms, read them carefully, complete them and bring them with you when you come to the Clinic.
Portal Family Access For Patients with Special Healthcare Needs
This form gives consent for a designated adult to provide and arrange medical care for a minor child that is not accompanied by either parent or legal guardian.
SPORTS FORM INSTRUCTIONS: - Complete part one. If there are any “yes” answers please include a brief written explanation. - In order for the MD to sign part 2, part 1 must be completed for the MD to review. - Include the following information on the sports form: o Pt’s name and date of birth o Phone number and fax number (if applicable) o When the form is due o How you would like us to return the completed form. Options include: fax, mail, pick up at front desk, or email (through our patient portal) Please allow 2-3 days for us to complete the form. IMPORTANT!!! If the patient’s most recent physical was over 2 years ago we CANNOT sign the form.
Authorization for The Children’s Clinic to Release Medical Information
Authorization for The Children’s Clinic to Receive Medical Information
TCC policy on Divorce, Separation & Custody matters involving patients and their parents.