Welcome to our practice!
We have included forms that you may download and complete prior to your office visit. Ask our staff when you are making an appointment if you will need any of these forms. Any student participating in high school sports or band will need a FHSAA EL2 school sports physical form completed yearly - ideally at the annual physical.
New Patient Forms:
- Patient Registration Form
- Initial Consent to Treat
- Financial Policy Form
- Lighthouse Pediatrics Office Policies
- Release of Records (Records Request)
- New Patient History Form
- Privacy Practices Statement
Additional Forms for Existing Patients:
- Consent to treat if parent not present
- School Medication Authorization
- FHSAA EL2 School Sports Physical Form
- Consent for Telehealth Services
We also have several forms and questionnaires available on CHADIS.com . If you have not registered on CHADIS, please contact our office for the invitation code. We also have the following questionnaires available if you are directed to download and complete these forms prior to your visit.
In order to view or print these forms, you will need Adobe Acrobat Reader installed.
Click here to download it.
