We are excited that you have chosen Southwest Children's Clinic for your child's medical care. Your comfort and convenience are our priority, and we strive to make every visit to our office a positive experience. To help you get acquainted with our office and first visit procedures, we have included helpful information on this page.
YOUR CHILDREN, OUR COMMITMENT
At Southwest Children's Clinic our mission is to support your family and
promote your child's physical development and emotional well-being. We
partner with families and treat all family members with compassion and
respect in a friendly and professional environment. We look forward to
meeting your family at Southwest Children's Clinic.
We are happy to provide our office forms for convenient download on your home computer. Please print and complete the forms below, and bring them with you to your child's first appointment. Questions about which forms you need? Please call our office and our courteous staff will assist you in preparing for your child's first visit.
New Patient Forms
- Patient/Family Information Form [ PDF ] [ Online Form ]
- HIPAA Form [ PDF ]
- Appointment of Personal Representative [ PDF ] [ Online Form ]
- Office Policies [ PDF ] [ Online Form ]
- Medical History [ PDF ] [ Online Form ]
- The release of Medical Information [ PDF ] [ Online Form ]
- Vanderbilt Assessment Scale - Teacher Informant [ PDF ] [ Online Form ]
- Vanderbilt Assessment Scale - Parent Informant [ PDF ] [ Online Form ]
- Notification Sheet [ Online Form ]
- Consent for Treatment, Payments and Healthcare Operations [ Online Form ]
In order to view or print these forms, you will need Adobe Acrobat Reader installed. Click here to download it.
The Initial Visit
Our compassionate city pediatricians do whatever it takes to make every visit to our office a pleasant, relaxed experience. With all of the important information about our practice available on our website, you can feel confident that you and child are well-prepared for your first appointment. We also invite you to review our staff page in order to get to know our doctors and staff. We look forward to meeting you.