Dear Parents/Caregivers:
Welcome and thank you for choosing Lindenhurst Pediatrics! We accept most health insurance plans, but suggest that you contact your insurance carrier to verify that we are included in your plan. We appreciate the opportunity to provide your child with the highest quality pediatric care. Please take a few minutes to fill out the following forms as completely and accurately as possible and review our policies. It is essential that we have, at a minimum, your child’s immunization record before your first visit.
On the day of your appointment please bring with you:
–Your completed registration forms
–Your insurance cards and photo identification (preferably driver’s license).
–Immunization records and any prescription medicines your child is taking.
–Any over-the-counter supplements your child is taking.
We look forward to meeting you and your child(ren). If you have any questions, please let us know at 847-356-5575. Comments and suggestions are always welcome!
To view the forms listed below, you will need Adobe Reader. You may download Adobe Reader for free at www.adobe.com. Please bring your completed forms with you to our office at the time of your visit.
New Patient Registration Forms:
- Family Registration Form (one per family)
- Patient Health History Form (one per patient)
- Acknowledgement of Financial and Privacy Policy (one per patient)
- Vaccine Policy (one per patient)
- Authorization to Accompany Child (optional) (authorizes a non-parent to bring child to appointment)
Our Office Policies: