• Visit Valley Children's Healthcare Website
  • Search
    • Language:
    • English
    • EspaƱol
Valley Childrens' Healthcare Logo
  • Find A Doctor
  • Our Locations
      • Bakersfield
      • San Dimas Pediatrics
      • Stockdale Pediatrics
      • Clovis/Fresno
      • Dakota Pediatrics
      • Fresno Children's Pediatrics
      • Sky Park Pediatrics
      • Magnolia Pediatrics
      • Merced
      • Olivewood Pediatrics
    • View Map
  • Parent Resources
      • Billing Information
      • Health Library
      • New Parent Resources
      • New Patient Forms
  • MyChart
  • Careers
  • About
  • Patient & Families

    Service A-Z >

    Adaptive Sports

    Service A-Z >

    Ambulatory Treatment

    Service A-Z >

    Anesthesiology

    Service A-Z >

    Asthma Management Program

    Service A-Z >

    Audiology

    Service A-Z >

    Autism Resources

    Service A-Z >

    Blood Disorders

    Service A-Z >

    Bloodless Medicine

    See full list of services
    • A
    • B
    • C
    • D
    • E
    • F
    • G
    • H
    • I
    • J
    • K
    • L
    • M
    • N
    • O
    • P
    • Q
    • R
    • S
    • T
    • U
    • V
    • W
    • X
    • Y
    • Z
  • Quality
  • For Healchcare Providers
  • Medical Education
  • Caers
  • Menu
    Valley Childrens' Healthcare Logo
    Search
    Valley Children's Medical Group  /  Parent Resources  /  New Patient Forms
    home

    Parent Resources

    • Billing Information
    • Health Library
    • New Parent Resources
      • Choosing a Pediatrician
      • Interviewing a Pediatrician
      • What to Pack in Your Hospital Bag
      • Newborn Well Child Schedule
    • New Patient Forms
    • Billing Information
    • Health Library
    • New Parent Resources
      • Choosing a Pediatrician
      • Interviewing a Pediatrician
      • What to Pack in Your Hospital Bag
      • Newborn Well Child Schedule
    • New Patient Forms

    New Patient Forms

    Once you've selected a Valley Children's pediatrician, be sure to bring your insurance card, immunization record, and the completed following forms to your first visit:

    Patient Registration Form | En Español
    Patient Health Information | En Español
    General Consent to Treatment | En Español
    Authorization for and Consent to Surgery or Procedures | En Español
    Financial Policy | En Español
    Third Party Consent Authorization | En Español
    Acknowledgement of Notice of Privacy | En Español
    Caregiver Affidavit | En Español

    Authorization to Use and/or Disclose Health Information:

    • Dakota Pediatrics | En Español
    • Fresno Children's Pediatrics | En Español
    • Magnolia Pediatrics | En Español
    • Olivewood Pediatrics | En Español
    • San Dimas Pediatrics | En Español
    • Sky Park Pediatrics | En Español
    • Stockdale Pediatrics | En Español
    home

    9300 Valley Children's Place
    Madera, CA 93636-8762
    559-353-3000

    • Language:
    • English
    • Español
    Staff & Affiliate Login
    • Facebook Twitter Youtube
    • Instagram LinkedIn Pinterest
    • Careers
    Staff & Affiliate Login
    • Copyright © Valley Children's Healthcare
    • Sitemap
    • Your Rights and Privacy
     
    Top