The following is a list of the paperwork necessary for the registration process.  Please look over each item to understand it’s purpose and then print the packet at the bottom of the list, complete the forms and bring them to your first office visit.

1. Registration Form will give us the basic information about your family and insurance.
2. Medical History Form will tell us about your child’s medical history.
3. Notice of Privacy Practice Consent Form (also known as the HIPPA Form) will let us know that you have read about our privacy practices (click here to review the privacy practices at Northwest Medical Group).
4. Appointment Reminder Consent Form will allow us to text or leave messages to remind you of upcoming appointments.
5. 24 Hour Cancellation & “No Show” Fee Policy explains our policy for appointment cancellations and appointment “no shows”.
6. Telehealth Informed Consent allows us to conduct telehealth sick visits as needed to accommodate your child.
7. Authorization to Use & Disclose Medical Information will allow NW Pediatrics to disclose information regarding the minor’s medical care to those non-guardian adult(s) listed on the form. This is optional and is typically for grandparents or other family members to bring child to appts when you are unable to.
8. Authorization for Release of Confidential Information is used to request medical information/records from your previous pediatrician. Only complete the highlighted items that may apply to you.