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 -
Consent For Treatment - When parent not present -
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 -
M-CHAT - Screening done at 18 months and 2 years appointments -