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SURFS IDE PEDIATRICS Dr. Kevin G. White M.D. 2660 E Main St, Ste 204 Ventura, CA 93003 Phone (805) 6437500 Fax (805) 6437510 www.surfsidepeds.com PATIENT INFORMATION Date of birth: / / Date of birth:

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How to fill out surfside pediatrics dr kevin

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To fill out the Surfside Pediatrics form for Dr. Kevin, follow these steps:

02

Start by providing your personal information, such as your name, date of birth, and contact details.

03

Next, provide details about your child, including their name, date of birth, and any relevant medical history.

04

Indicate the reason for your visit and any specific concerns or symptoms your child is experiencing.

05

Fill out the insurance information section, including the name of your insurance provider and policy details.

06

If applicable, authorize the release of medical records by signing the appropriate consent form.

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Review the form for accuracy and completeness before submitting it.

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Finally, return the completed form to Surfside Pediatrics or submit it online as instructed by the clinic.

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Surfside Pediatrics with Dr. Kevin is suitable for anyone who requires pediatric medical care for their child.

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This may include parents or legal guardians of infants, children, or adolescents who are in need of routine check-ups, vaccinations,

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management of chronic conditions, treatment of illnesses or injuries, and any other pediatric healthcare services.

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Dr. Kevin and the team at Surfside Pediatrics are dedicated to providing comprehensive care to children of all ages and their families.

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What is surfside pediatrics dr kevin?

Surfside Pediatrics Dr. Kevin is a pediatric medical practice run by Dr. Kevin.

Who is required to file surfside pediatrics dr kevin?

All patients who receive medical services from Surfside Pediatrics Dr. Kevin are required to file.

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To fill out Surfside Pediatrics Dr. Kevin, patients need to provide their personal information, medical history, and details of the services received.

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The purpose of Surfside Pediatrics Dr. Kevin is to maintain accurate records of patient visits and treatments.

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Patients must report their personal information, medical history, and details of the services received on Surfside Pediatrics Dr. Kevin.

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