Search this site
Embedded Files
Skip to main content
Skip to navigation
The Pediatric Center
Home
New Mom and Dad Classes
Covid-19 Updates
RSV Prevention
Scheduling Your Visit
Directions
Patient Survey
Bill Pay
Our Providers
Our Providers
Patrick Edwards, MD
Eric Jackson, MD
Jennifer Player, MD
Patrick Renton, MD
Brittany Bradshaw, CPNP
Our Practice
Our Practice
Our Staff
Our Mission Statement
Take a Tour
Patient Portal
After Hours Questions
Insurance Coverage
A Patient Centered Medical Home
Forms
Forms
Patient Information and Demographics
Parent Consent
Vaccine Policy
Insurance Policy
Appointment Policy
Prescription Medication Consent
Financial Policy
Release of Medical Information
Authorization For Release
HIPAA Signature Form
HIPAA Privacy Policy
6 - 10 Year Olds
11 - 17 Year Olds
ADHD-ADD Parent Evaluation
ADHD-ADD Teacher Evaluation
ADHD-ADD Parent FOLLOW-UP Form
Depression Screening Form
Anxiety Screening Form
Suggested Sites
The Pediatric Center
Home
New Mom and Dad Classes
Covid-19 Updates
RSV Prevention
Scheduling Your Visit
Directions
Patient Survey
Bill Pay
Our Providers
Our Providers
Patrick Edwards, MD
Eric Jackson, MD
Jennifer Player, MD
Patrick Renton, MD
Brittany Bradshaw, CPNP
Our Practice
Our Practice
Our Staff
Our Mission Statement
Take a Tour
Patient Portal
After Hours Questions
Insurance Coverage
A Patient Centered Medical Home
Forms
Forms
Patient Information and Demographics
Parent Consent
Vaccine Policy
Insurance Policy
Appointment Policy
Prescription Medication Consent
Financial Policy
Release of Medical Information
Authorization For Release
HIPAA Signature Form
HIPAA Privacy Policy
6 - 10 Year Olds
11 - 17 Year Olds
ADHD-ADD Parent Evaluation
ADHD-ADD Teacher Evaluation
ADHD-ADD Parent FOLLOW-UP Form
Depression Screening Form
Anxiety Screening Form
Suggested Sites
More
Home
New Mom and Dad Classes
Covid-19 Updates
RSV Prevention
Scheduling Your Visit
Directions
Patient Survey
Bill Pay
Our Providers
Our Providers
Patrick Edwards, MD
Eric Jackson, MD
Jennifer Player, MD
Patrick Renton, MD
Brittany Bradshaw, CPNP
Our Practice
Our Practice
Our Staff
Our Mission Statement
Take a Tour
Patient Portal
After Hours Questions
Insurance Coverage
A Patient Centered Medical Home
Forms
Forms
Patient Information and Demographics
Parent Consent
Vaccine Policy
Insurance Policy
Appointment Policy
Prescription Medication Consent
Financial Policy
Release of Medical Information
Authorization For Release
HIPAA Signature Form
HIPAA Privacy Policy
6 - 10 Year Olds
11 - 17 Year Olds
ADHD-ADD Parent Evaluation
ADHD-ADD Teacher Evaluation
ADHD-ADD Parent FOLLOW-UP Form
Depression Screening Form
Anxiety Screening Form
Suggested Sites
Authorization For Release
patientauthorizationforrelease.docx
Google Sites
Report abuse
Page details
Page updated
Google Sites
Report abuse
patientauthorizationforrelease.docx