Forms and Policies

Las Vegas Pediatricians - VIP Club Las Vegas Pediatric OfficeFor your convenience prior to visiting our office, print all necessary forms on our Office Forms and Policies page. Complete the information and bring it with you to your first visit.

In English

PATIENT INFORMATION - Download
NEW PATIENT (0-1 YEARS OLD) - Download
NEW PATIENT (1-18 YEARS OLD) - Download
WELL CHECK - Download
HIPAA-NOTICE OF PRIVACY PRACTICES - Download
HIPAA ACKNOWLEDGEMENT FORM - Download

In Spanish

FORMULARIO DE INFORMACION (DE RECIEN NACIDO A 1 AÑO DE EDAD) -Download
FORMULARIO DE INFORMACION PARA NUEVOS PACIENTES (DE 1 A 18 AÑOS DE EDAD) - Download
REVISION MÉDICA (EXAMEN DE SALUD) APERCIBIMIENTO - DownloadLas Vegas Pediatricians - Testimonials for Las Vegas Pediatric Office

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