Patient Forms
New Patient Registration Packet (PDF)
All new patients must complete this packet at least 7 days prior to their initial consultation appointment
Authorization and Consent for Treatment (PDF) or Autorización y Consentimiento Para el Tratamiento
All patients must provide their consent for treatment, communications (calls, emails, and text messaging), and agreement of financial responsibility.
This form must be completed annually
Annual Non-Covered Services Fee Agreement
To offset these costs and maintain a seamless experience for our patients and families, we charge an annual $50 Non-Covered Services Fee per child. This fee is due upon your child’s enrollment in the practice and will be billed annually.
Authorization for Release of Medical Information (PDF) or Autorización De HIPAA Para Divulgar Información Del Paciente
Allows patients to authorize the disclosure of their health information to a designated individual, company, agency, or facility.
Preferred Contacts (PDF) or Contactos Preferidos
Patients are encouraged to complete and return the Preferred Contacts Form but it is not required.
Authorizes Thrive and Grow Pediatric Endocrinology to obtain previous medical records
Office Policies
Financial Policy (PDF) or Política Financiera (PDF)
This form advises patients of their complete financial responsibility for all medical services received without regard to insurance eligibility or coverage determinations.
Notice of Privacy Practices (PDF) or Aviso de prácticas de privacidad (PDF)
Describes how health information about you (as a patient of this Care Center) may be used and disclosed, and how you can get access to your individually identifiable health information. Please review this notice carefully.