New Patient History Form
Release of Health Information/Records

Welcome to Lighthouse Pediatrics! We are pleased that you have chosen to establish your child in this special practice. In order for us to use your time with the doctor wisely, could you please take a few moments to complete the following information about your child?




 












ADD/ADHD
Allergies
Arthritis
Asthma
Cancer
Cardiac Disease
Crohn's oor Ulcerative Colitis

Diabetes
Drug/Alcohol Abuse
High blood pressure
High cholesterol
Migraines
Prolonged QT syndrome
Seizure

Sickle cell
Sudden Unexplained death
Thyroid Disorders
Vision/Hearing disorders
Other










 



 





Contact Us

If you are an established patient, please use the portal.  Click below to go to the portal website:  If you are not already registered for the portal, you may call the office to sign-up.

Lighthouse Pediatrics Portal

You may use the form below to request NON-urgent appointments.  Please do not include personal health information.

Our Location

Office Hours
Monday:8:30 AM - 5:00 PM
Tuesday:8:30 AM - 5:00 PM
Wednesday:8:30 AM - 5:00 PM
Thursday:8:30 AM - 5:00 PM
Friday:8:30 AM - 5:00 PM
Saturday:Closed
Sunday:Closed