Patient Forms

Thank you for choosing Allied Pediatrics. We look forward to caring for your child. Listed below are our patient forms. If you prefer, you may download these forms in advance, complete them and bring them with you to your first visit.

All of our forms are in PDF format, so you will need Adobe Acrobat installed on your computer in order to view them.


Authorization For Alternate Caretakers

Use this form to authorize alternate caretakers to bring children to their appointments at Allied Pediatrics.


New Patient Forms

These forms are for new patients that will be using Allied Pediatrics as their primary care provider (PCP). To save time at your first appointment fill out these forms before arriving and bring them with you.


New Patient Frenotomy Forms

These forms are for new patients that will be using Allied Pediatrics one time for a frenotomy. To save time at your appointment fill out these forms before arriving and bring them with you.


Recommended Vaccine Schedule

This is the vaccine schedule that Allied Pediatrics recommends.