Review and complete this packet prior to your first pediatric primary care appointment.
This is the LA Unified School District Sports Physical Form. Complete your portion of the form before arriving to your appointment.
Complete this form if you are not able to be present for your child and wish to have another adult accompany your child.
This consent form is needed for vaccination
This consent form is needed for annual influenza vaccination
This consent form is needed for ear piercing.
This consent form is needed for medical procedures.
This is an emergency contact list for LA county
Complete this form at or prior to your first Urgent Care visit with us.
Authorization to obtain your records from another clinic or hospital.
This allows MediCAL patients to pay for services that are not covered by MediCAL or for MediCAL plans that we do not accept.
This is our credit card authorization form to be signed by the patient or the person who is financially responsible for the patient.
Complete this form prior to your house call visit.
This form helps to assess your child for ADHD.
This form helps to assess your child’s risk for lead poisoning.
This form is for TB skin test.
