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.

Please be aware that when forms are dropped off to be completed/reviewed/signed by a doctor, we do ask that you allow 3-5 business days for this process. We do our best to complete these forms as soon as possible, but due to volume and staffing, we unfortunately are not always able to accommodate requests for immediate turnaround. Thank you for understanding!

18+ registry update

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

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RElease of info form

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

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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.

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18+ privacy form

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

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Records release form

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

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