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Date: Annual Verification/Date/initials Best Contact Number to Reach You: Chart # Patient Information:Please List All Children in the FamilyLast First Middle Birthdate Gender Race Nickname 1. 2. 3.
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Start by obtaining the welcome to pediatric associates form from the front desk or by downloading it online.
02
Fill out your personal information such as your name, date of birth, and contact details.
03
Provide your child's information including their name, date of birth, and any known medical conditions or allergies.
04
Indicate any emergency contact information and insurance details.
05
Sign and date the form to certify that the information provided is accurate.
06
Return the completed form to the front desk staff or follow any specific instructions provided.

Who needs welcome to pediatric associates?

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Any new patient or parent/guardian of a new patient who is visiting Pediatric Associates for the first time.
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Welcome to Pediatric Associates is a form or document that new patients fill out when visiting a pediatrician's office for the first time.
Parents or legal guardians of new pediatric patients are required to fill out the welcome to pediatric associates form.
To fill out the welcome to pediatric associates form, parents or legal guardians need to provide detailed information about the child's medical history, insurance information, and contact details.
The purpose of the welcome to pediatric associates form is to gather necessary information about the new patient so that the pediatrician can provide appropriate medical care.
Information such as the child's medical history, current medications, allergies, insurance details, and emergency contact information must be reported on the welcome to pediatric associates form.
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