FORMS FOR NEW PATIENTS
Expected Newborn Form
Use this form if you are expecting a baby or if your newborn has not yet had their first visit.
Patient Registration Form
Use this form for older children or for families transferring care to Brentwood Pediatrics
RECORDS AND AUTHORIZATION FORMS
Authorization to Release Medical Records
Use this form to request your child’s medical records be sent to or obtained from another provider, specialist, school, or healthcare facility.
Medical Release Form
Use this form if you would like to authorize a grandparent, caregiver, babysitter, nanny, or another trusted adult to bring your child for a visit or make medical decisions in your absence. If parents are divorced or separated and one parent has sole or primary medical decision-making authority, please provide documentation so we can update your child’s chart accordingly.