Filling out forms before a visit can save time on an office visit. Feel free to print these forms, read them carefully, complete them and bring them with you when you come to the Clinic.

Patient Bill of Rights and Responsibilites

TCC Financial Policy

Notification and Opt-out Statement & Form

Notificación y Forma de Opción de Exclusión

Health History Form Over One Month Spanish

Health History Form Over One Month

Health History Form Under One Month Spanish

Health History Form Under One Month

Generic Sports Form

SPORTS FORM INSTRUCTIONS: - Complete part one. If there are any “yes” answers please include a brief written explanation. - In order for the MD to sign part 2, part 1 must be completed for the MD to review. - Include the following information on the sports form: o Pt’s name and date of birth o Phone number and fax number (if applicable) o When the form is due o How you would like us to return the completed form. Options include: fax, mail, pick up at front desk, or email (through our patient portal) Please allow 2-3 days for us to complete the form. IMPORTANT!!! If the patient’s most recent physical was over 2 years ago we CANNOT sign the form.

Medical Release Form

Authorization for The Children’s Clinic to Release Medical Information

Iron Rich Foods Spanish

Calcium Containing Foods Spanish

Feeding Solid Foods Spanish

Iron Rich Foods

Fever Handout Spanish

Calcium Containing Foods

Fever Handout

Feeding Solid Foods

Receiving Medical Information

Authorization for The Children’s Clinic to Receive Medical Information

Acetaminophen/Ibuprofen Dosing Chart

Divorce, Separation & Custody

TCC policy on Divorce, Separation & Custody matters involving patients and their parents.

Permission To Treat

Please Bring this form in on your first visit with us in order to avoid a longer wait time in the office