health care for infants, children and adolescents in grants pass, oregon 
pediatrician southern oregon  

FAQ - New Patient Registration Form  Answer To Frequently Asked Child Medical Question

New Patient Registration Form

Please print all documents that are labeled New Patient as this is your packet and these are required forms to be a new patient with Siskiyou Pediatric Clinic. Please have these forms filled out completely and bring them to our office at time of appointment. If you would prefer to get them in before appointment you can fax the New Patient packet to (541) 955-0983 or drop by our office during office hours prior to scheduled appointment.

[click on the icon to view or download the pdf]
Parental Consent

Grants Pass Pediatrics Clinic document
download
parental-consent-7-1.pdf

Authorization to Disclose Health Info

Grants Pass Pediatrics Clinic document
download
authorization-to-disclose-health-info-7-1.pdf

Acknowledgement and Consent Form

Grants Pass Pediatrics Clinic document
download
acknowledgement-and-consent-8-1-16.pdf

Adolescent Questionnaire for Parent

Grants Pass Pediatrics Clinic document
download
adolescent-questionnaire-for-parent-5-15.pdf

Letter to the Parent

Grants Pass Pediatrics Clinic document
download
letter-to-the-parents-7-1-16.pdf

Adolescent Questionnaire

Grants Pass Pediatrics Clinic document
download
adolescent-questionnaire-for-teen-9-1-14.pdf

Letter to the Teen

Grants Pass Pediatrics Clinic document
download
letter-to-the-teen-7-1-16.pdf

Tips for Teens

Grants Pass Pediatrics Clinic document
download
tips-for-teens-cover-letter-7-1-16.pdf


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700 SW Ramsey Avenue, Suite 204, Grants Pass, OR 97527 Phone 541.955.LOVE (5683)
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