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Forms & Policies


For your convenience prior to visiting our office, print and complete the necessary information listed below and bring it with you to your first visit.

  1. Read through our Privacy Notice and Memo.  This details how we protect your medical information.
  2. Fill out the Patient History Forms.  These let us know some of the family medical history and about some of the chronic illnesses present in the child. (Download)
  3. Sign both the Acknowledgement and Signature Forms.  These are used to verify that you have read over our privacy practices and understand our policies. (Download)

  

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Welcome to Shelby Pediatrics - A piece of home for your children, a peace of mind for you.