Instructions

Click on the links below to download and print forms related to medical care at Midway Pediatrics. Completed forms can be presented at the time of appointment to lessen your waiting time.  Please review the following information for successfully completing a fillable pdf form:

• Only use the latest version of Adobe Reader to complete fillable PDF forms.  Both MacIntosh (Apple) and Windows versions of Acrobet Adobe Reader are available free from Adobe.  Click here to get it.
• Before completing the document, save the form (PDF format) to a location on your computer.
• Some forms have a SUBMIT button built into the form that will allow you to submit the form via email directly from the form. These forms will be automatically attached to your email when you click the SUBMIT button.

Forms

Forms to download, print copies, and complete.

• New Patient Registration (English)
• New Patient Registration (Spanish)
• General Consent to Outpatient Treatment (English & Spanish)
• Patient Representative Non-Parent (English & Spanish)
• Acknowledgement of Privacy Practices (English & Spanish)
• AHSAA Physical (Sports) Form 5 Rev. 2018