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Allevato Pediatrics

A member of the CHOC Primary Care Network

Patient Forms

child and mother with nurse doctors office

To expedite your visit with us, print and fill out the forms below ahead of your appointment.

New Patient Forms

New Patient FormDownload
Newborn New Patient FormDownload

Medical Record Release

Records Release for Allevator Pediatrics to get your records from a previous providerDownload
Records Release for Allevato Pediatrics to send your records to another practiceDownload

Additional Forms

Consent for another adult besides a parent to approve care for a minorDownload
Financial ResponsibilityDownload
Missed AppointmentDownload
Photo ReleaseDownload

COVID-19 Screening Questionnaire

English COVID-19 Screening Questionnaire and ConsentDownload
Spanish COVID-19 Screening Questionnaire and ConsentDownload
Vietnamese COVID-19 Screening Questionnaire and ConsentDownload