Parker Pediatrics & Adolescents, P 2026

1. Click ‘Get Form’ to open the Parker Pediatrics & Adolescents, P Family Form in the editor.
2. Begin by filling out the 'Patient Information' section. Indicate how you heard about the practice by selecting from options like 'Friend', 'Internet', or 'Referral'.
3. In the 'PATIENT DATA' section, list each child in your family. Fill in their last name, first name, date of birth, gender, and who they reside with.
4. Complete the 'TELEPHONE NUMBERS' section by providing a primary contact number for appointment reminders and additional numbers as needed.
5. Fill out the 'PARENT / GUARDIAN INFORMATION' section with details about both parents or guardians, including names, relationship to child, and contact information.
6. Review and complete the 'INSURANCE DATA' section if applicable. Ensure all insurance details are accurate for billing purposes.
7. Finally, read through the policies regarding vaccines and consent for payment. Initial where required and provide your signature at the bottom of the form.

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