Ellenton pediatrics 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering today’s date at the top of the form. This helps keep your records organized.
3. In the 'Patient's Information' section, provide your child's legal last name, first name, middle name, and nickname. Ensure accuracy as this information is crucial for identification.
4. Fill in your child's birth date, weight, age, and sex. This data is essential for medical history.
5. Complete the address fields including city, state, and ZIP code. Also indicate primary language and ethnicity.
6. In the 'Parents’ Information' section, enter both parents' details including names, contact numbers, emails, occupations, and employers.
7. Proceed to fill out the 'Pregnancy and Birth Information' section with relevant details about the pregnancy and delivery.
8. Continue through sections on past medical history and family medical history by checking applicable boxes and providing additional information where necessary.
9. Finally, review all entered information for accuracy before signing at the bottom of the form to authorize treatment and release of information.

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