Forms

Healing Hearts Pediatrics, P.L.C., follows the outlined Well Child Visit Schedule below. Please print, complete, and bring all age-appropriate forms to your scheduled appointment. Visits in parenthesis do not require paperwork to be printed off in advance.

Well Child Visit Schedule:

Newborn/New Patient 24 Month-Old Well Visit
Newborn/New Patient – Spanish 30 Month-Old Well Visit
1 Month-Old Well Visit 3 Year-Old Well Visit
2 Month-Old Well Visit 4 Year-Old Well Visit
4 Month-Old Well Visit 5 Year-Old Well Visit
6 Month-Old Well Visit 6-8 Year-Old Well Visit
9 Month-Old Well Visit 8-10 Year-Old Well Visit
12 Month-Old Well Visit 10-12 Year-Old Well Visit
15 Month-Old Well Visit 13-17 Year-Old Well Visit
18 Month-Old Well Visit

Allergy Testing Forms:

Allergy Skin Test Consent Packet

Other Patient Forms:

  • Notice of Privacy Practices & Patient Responsibilities
  • Authorization to Treat (requests for authorizing  treatment other than that of  the legal guardian need to be made in person and requested by the legal guardian)
  • Request for Medical Records

Click here to visit our Patient Portal for additional resources.