Royale Pediatric

We are happy to provide our office forms for convenient download on your home computer. Please print, complete, and bring them with you to your child's first appointment.

Questions about which forms you need? Call our office for assistance in preparing for your child's first visit.

 

Patient Registration  [PDF]

Medical History  [PDF]

Notice of Privacy Practices  [PDF]
Privacy Practice Acknowledgement  [PDF]
Protected Health Information Consent  [PDF]

Healthix FAQ  [PDF]
Healthix Consent - English  [PDF]

Healthix Consent - Spanish  [PDF]

Healthix Consent - Haitian Creole  [PDF​]​

In order to view or print these forms you will need Adobe Acrobat Reader installed - click here to download it