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Children’s Medical Center
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  • About Us
    • COVID-19 Info
    • Careers
  • Meet Our Physicians
    • Khan Adnan, MD
    • Alfred Alvarez, M.D.
    • Christine Armstrong, M.D.
    • Beatriz Arvelo-Sankey, M.D.
    • Antigone Athanasatos, D.O.
    • Janet Black, M.D.
    • Taylor Alberdi Bradley, M.D.
    • Lara Cavanaugh, M.D.
    • Lisa Cronin, M.D.
    • James Dwyer, M.D.
    • Sonia Farooqi, M.D.
    • Natasha Hughes, M.D.
    • Jay Klein, M.D.
    • Paul Mitchell, M.D.
    • Efstratios Pantages, M.D.
    • Dolores Razman, M.D.
    • Duane Rommel, M.D.
    • Jennifer Sawka, M.D.
    • Charlene Weber, M.D.
    • Ellyn Theophilopoulos, M.D.
    • LeighAnn Riemer, D.O.
  • Services & Specialties
    • Expecting Parents/Prenatal Visits
    • Newborns
    • Lactation Services
    • Early Childhood Care
    • School Age
    • Adolescent Care
    • Vaccines & Immunizations
    • Sick Visits/Urgent Care
    • Telemedicine
    • Nutrition
    • Behavioral & Development
    • Mental Health
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    • Patient Forms
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    • Helpful Links & Info
    • Insurances Accepted
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  • Contact & Locations
    • Palm Harbor
    • Westchase
    • Trinity
    • Lutz

Patient Forms

To expedite your first appointment, please arrive a few minutes early to complete registration forms so that we have all the necessary information to treat your child. You may also download and print the forms from this website, fill them out ahead of time, and bring them with you to the first appointment.

Forms Packet

  • New Patient Forms Packet
  • Newborn Patient Forms Packet
  • Annual Packet

Individual Forms

For your convenience you may download and print our forms individually. Please bring the completed documents to your first visit.

  • Patient Contact Form
  • Medical Release Form to obtain records
  • Medical Release Form to release records
  • Medical Treatment of a Minor Authorization Form
  • HIPAA Notice of Privacy Practices
  • Financial Policy
  • Pharmacy Update
  • Patient Appointment Cancellation and No-Show Policy
  • Forms Charge Policy
  • Consent Agreement Treatment
  • Children’s Medical Center Vaccine Statement
  • Patient Portal Form
  • 18 Years or Older Authorization to Release Medical Information to Parent/Care Giver

Patient Grievance

  • Patient Grievance Policy
  • Patient Grievance Form

In order to view or print these forms, you will need Adobe Acrobat Reader installed.


Click here to download it
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pediatrician talking to little girl

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PATIENT REVIEWS

As a result of the compassionate care we deliver, we often hear from our patients about how our doctors and staff have helped them. Here are some of our favorite reviews.

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We love this location! All staff members are friendly, caring, and very knowledgeable! We have see a few different Dr.'s at this location and were very pleased with all of them!

Brittany W.

Mother

PATIENT EDUCATION

Do you want to know more about the wide range of conditions we treat at Children’s Medical Center? Check out our exclusive A-Z patient education library!

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CHILDREN’S MEDICAL CENTER BLOG

Share the latest updates and information in the field of pediatrics, while keeping up on news about our practice with Children’s Medical Center’s extensive collection of blog articles.

Learn More
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At Children’s Medical Center, some of our pediatric services and specialties include Routine well-care, Adolescent care, Newborn care, Early childhood care, School age care Adolescent care, Adolescent care, Vaccinations and immunizations, Sick visits/urgent care, Sports physicals, Telemedicine, Lactation Center, Registered Dietitian, ADHD/ADD management, Telemedicine, Nutrition, Behavioral & Development, and Mental Health.