Please download this form, print both pages and fill out all information prior to your appointment. Thank you.
Change of Address and Information Form (PDF)
The Right to Contact Form
Hixny Electronic Data Access Consent Form
Informed Consent Release of Information Form (PDF)
Office and Billing Policy Form (PDF)
This form explains our office and billing policies. Download the form, print it and fill out all information. You can then mail, fax or bring it to our office.
Your Information. Your Rights. Your Responsibilities.
Request Release of Information (PDF)
Use this form to allow schools, daycare providers, relatives or friends to obtain medical information or pick up prescriptions for your child. Download the form, print it and fill out all information. You can then mail, fax or bring it to our office. Please allow at least 2 weekdays for information to be released.
Request a Transfer of Records (PDF)
Use this form to transfer records to or from Mountain View Pediatrics and another facility. Download the form, print it and fill out all information. You can then mail, fax or bring it to our office. Please allow 1 week for records to be ready for pick up or mailing.
At most check-ups, we'll ask you to complete a few screening forms before seeing the doctor or nurse. The questions on these forms change based on your child's age.
Mountain View Pediatrics provides forms that you can print and fill out in advance to save you office time and simplify the process. These forms are in the standard Adobe PDF format, which comes pre-installed on most computers. (see bottom of page)
Thank you for filling out the forms, and for helping us provide the best possible care for your child. Read more about our forms here.
Please download this form, print both pages and fill out all information prior to your appointment. Thank you.
Change of Address and Information Form (PDF)
The Right to Contact Form
Hixny Electronic Data Access Consent Form
Informed Consent Release of Information Form (PDF)
Office and Billing Policy Form (PDF)
This form explains our office and billing policies. Download the form, print it and fill out all information. You can then mail, fax or bring it to our office.
Your Information. Your Rights. Your Responsibilities.
Request Release of Information (PDF)
Use this form to allow schools, daycare providers, relatives or friends to obtain medical information or pick up prescriptions for your child. Download the form, print it and fill out all information. You can then mail, fax or bring it to our office. Please allow at least 2 weekdays for information to be released.
Request a Transfer of Records (PDF)
Use this form to transfer records to or from Mountain View Pediatrics and another facility. Download the form, print it and fill out all information. You can then mail, fax or bring it to our office. Please allow 1 week for records to be ready for pick up or mailing.
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