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Patient Forms

For new patients to Altos Pediatrics, we will need a Past Medical History, Family Medical History and Patient Registration form completed at the time of your first visit. You may download these now or complete them in the office.

For you convenience, we have also provided Records In and Records Out forms as well. Note there is a $15 dollar charge for out-going medical records. Please allow a one-week turn around time.

Past Medical History(.pdf)
Family Medical History(.pdf)
Patient Registration(.pdf)
Records In(.pdf)
Records Out(.pdf)

School and Camp Forms

There is no charge for school, camp, or other forms IF the customary 3 day turn around time is observed. Please complete as much of the form as possible including medication doses and timing. For forms that need to be expedited in a shorter time frame, there is a $20 service charge.