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Mother and Baby on Floor

Forms

Below you will find some forms you may need during your time with our office. To submit a form, please download it, complete it, and return it to our office via mail, fax, our office email (algerped@algerpediatrics.com), or in person. These forms are also available at our office. Please stop by at any time during our open hours to request them.

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We typically ask for 2-3 business days for our physicians/nurses to review, complete, and return any submitted forms. Thank you for understanding. 

18+ registry update

Please submit your updated address and contact information to our office once you turn 18.

information disclosure form

Please submit this form to share a patient's medical information with another party, such as as a grandparent or guardian. 

sports physical form

Please complete the health history portion of this form and return it to our office to be signed by a doctor/nurse.

18+ privacy form

For patients 18+ to share medical information with another party, such as a parent or guardian, submit this form. 

Records release form

To have your records transferred to a different office or sent directly to you, please complete and submit this form.

Alger Pediatrics

​733 Alger St. SE

Grand Rapids, MI 49507

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P: 616-243-9515

F: 616-243-1815

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