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
- Fl Sports Form (EL2) 7/25
- Consent for Telehealth Services
We also have several forms and questionnaires available on CHADIS.com . Our patients log into their patient portal to complete a CHADIS questionnaire. Patients are asked to contact the office to have the correct questionnaires sent . A front staff member can assist you to get the correct questionnaires sent out to you.
In order to view or print these forms, you will need Adobe Acrobat Reader installed.
Click here to download it.
