First visit forms

Thank you for choosing the Children's Clinic of SWLA.
For your convenience the following forms are available for printing and completion before you arrive for your first appointment. The first four are required to register your child as a patient.
If your child is a newborn, you do not need these forms if our doctors treated your baby in the hospital.

If your child's previous records need to be sent to us, you can print and complete the Medical Records Release form and mail it to your previous medical provider.

Patient Registration
Initial History
Notice of Privacy Policy
Financial Policy
Medical Records Release (optional)

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