FORMS & POLICIES
Required Registration Forms
- Patient Registration Form
- General Office Policies
- Financial Policies
- HIPAA (Notice of Privacy Practices)
- Authorization to Release Medical Records/Information
- CHADIS (Child Health & Development Interactive System)
Only one form is necessary for each family.
Why do I need to fill out CHADIS?
How do I access CHADIS?
CHADIS SIGN-IN
(First Time User Only)
First time users, click the above link
Input the invitation code: 7038655437
Create your user ID and Password
(First Time User Only)
First time users, click the above link
Input the invitation code: 7038655437
Create your user ID and Password
General Forms
- Authorization of Delegate - Adult
When patient is 18 or older and wants to authorize access of his/her info or act on his/her behalf (i.e. parent, grandparent). - Authorization of Delegate - Minor
For legally authorized patient representatives (parent/guardian) of a patient under 18 to delegate another person to act on the representative's behalf (i.e. grandparent, aunt). - Childhood Immunization Q&A
- AAP Vaccine Safety Fact Sheet
- Vaccine Administration Consent Form
- Vaccine Administration Refusal Form
- COVID-19 Vaccination Acknowledgement Form
School Forms
