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Forms & Policies

Patient Registration

Please complete these forms and bring them with you to your first appointment!

School Forms

Medical Records

This form is used when you are requesting your previous physician to send us your child's medical records.
This form can be used if you are requesting Milestone Pediatrics release your child's medical records to another physician, office, or yourself.

Other Forms

This form is used to evaluated for ADD/ADHD. Please give a copy to each one of your child's teachers to complete.
This form is the parent portion of the ADD/ADHD evaluation. Please complete the parent part of the paperwork prior to the appointment.
Please complete this form and bring it with you to your ADD or ADHD follow-up appointments.
MyChart Adult Proxy Access for patients 18 years or older.
MyChart Guardian Form for Patients 12-17 years old unable to sign authorization form
MyChart Information Page
MyChart Parent Form for Patients 12-17 years old