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New Patient Information

Welcome To Our Practice!

Thank you for putting your trust in us! Here is some important information to make your first visits easier.

Patient Portal

Pediatric & Adolescent Medicine LLP is proud to offer a Patient Portal. The Patient Portal provides families the ability to communicate with our office 24 hours a day.

To sign up, provide your email address to one of our receptionists. They will send you a temporary password. Each child needs their own account.

Some Important Tasks You Can Do Through The Patient Portal

  • Update or correct your contact information.
  • Print out immunization records.
  • Send secure messages to the doctors, staff, or billing.
  • Request prescription refills.
  • Request insurance referral to specialists.
  • Review billing statements.

To access your child’s records, you can log in through the Healow app or access the Patient Center on our website using our unique practice code, FJACCA.

Patient Portal

Before Your Visit

The first visit to the office requires the review of records from your previous pediatrician, your insurance information, and patient information sheets. Please arrive at least 15 minutes before your appointment. Using the Patient Portal, you can download, fill out, and sign many documents in advance.

  • Demographics: Please complete the Patient Information Form and print it out. Any future changes can be made directly on the Patient Portal.
  • Preferred Pharmacy: Please provide us with a preferred pharmacy. This can be changed at any time on the Patient Portal.
  • Consent Forms: Federal laws require us to give you information about our privacy practices, financial policies, and have your consent to use email. This can be found on our Patient Portal.
  • Transfer of medical records: Please download the Medical Record Request, sign, and send to your previous pediatrician. Please allow enough time for the records to be received and processed by our office.
  • Family History Form: This form can be completed on the Patient Portal. You will find it under Questionnaires, Medical History.

If your first visit is a Newborn Visit, please bring all records: immunization card, hearing test results, metabolic screen receipt, and discharge summary.

View All Forms

At Each Visit

  • Please bring your current insurance card to every visit.
  • Bring all school and camp forms. Please write your child’s name and date of birth on every page of the forms. Please indicate any allergies, dietary restrictions, and medications.
  • Your child’s information needs to be reviewed annually. You can update your information securely on the Patient Portal or with our receptionists at check-in. It is very important that we have accurate contact information.

Download Forms

NEW PATIENTS

Medical Record Request Forms

Please download, sign, and send to your CURRENT pediatrician. Please allow enough time for the records to be received and processed by our office.

EXISTING PATIENTS

Medical Record Release Form

Please download, sign, and send to our office. Allow up to 7 to 10 business days for processing your form.

Medical Record Release Form

M-CHAT

Questionnaire Form

The M-CHAT is administered as part of the 18-month and 24-month Well Child Visits to help screen for developmental problems.

M-CHAT Form

VANDERBILT ASSESSMENT SCALE FORMS

Questionnaire Forms for Parents and Teachers

If requested by your provider as part of ADHD management.

POLICY FOR DIVORCED OR SEPARATED PARENTS

Consent Form

Please download, sign, and send to our office. Allow up to 7 to 10 business days for processing your form.

Consent Form
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