Documents

Please use the following links to download these helpful Cherry Tree Pediatrics documents.  Feel free to view, download, print, and fill out before your visit if applicable.


Patient Demographics - Need to be updated every year for each patient -

Patient Demographics


Consent For Treatment - When parent not present -

Consent for Treatment of a Minor Without a Parent Present

Consent for Treatment of a Child Accompanied a Non-Parent Adult


HIPPA Forms - Must be read and the acknowledgement signed for each patient -

HIPPA Privacy Notice (Read This)

Acknowledgement of Receipt of HIPPA Privacy Notice (Print and Sign This!)


WIC Form - Used for infants and children who are enrolled in WIC but have special dietary requirements -

WIC Form


M-CHAT - Screening done at 18 months and 2 years appointments -

M-CHAT


Immunization Schedules

Birth Through 6 Years

7 Through 18 Years