Patient Forms
Transfer Records Request
Completion of this form allows us to obtain your child’s medical records from their previous doctors.
Social Media Consent
This optional form allows you to choose how photos of your child may (or may not!) be used by Greater Cleveland Pediatrics. Don’t worry, only fun photos would ever be taken and would only be used for the purposes of showing how great it is to be a patient of Greater Cleveland Pediatrics!
Medical History Form
Please complete this form to the best of your ability to give us a well-rounded view of your child’s medical history.
Greater than 18-year-old Consent
This form needs to be completed by all patients who are older than 18 years of age. Now that you are officially an adult, it is time to take control over your medical information! This form will specifically guide us regarding which information we are allowed to share (or not share!) with anyone (i.e., parents) who is not the patient.
Consent to Accompany a Minor
This optional form allows non-parent caregivers (such as a nanny or grandparent) to bring your child to an appointment in your absence.
Prenatal Information Form
This form is for families expected a new baby! Please complete so that we have all of the information to care for your new arrival!