top of page

forms

Authorization to Release Medical Information

Policies for Refilling ADD and ADHD Medications

Patient Registration Form

Patient Information Form

Family Sheet

Privacy Practices Acknowledgement Sheet

Consent Form for Minor Office Visit

Payment Policies

MyChart Adolescent Proxy Form

vaccine schedule & handouts

Immunizations.png

DTaP 

Flu

IPV

Men B

Hep A

Meningitis

Hep B

MMR

Hib

PCV13

HPV

RV

Td

Tdap

Varicella

COVID-19 

©2022 Premiere Pediatrics, 7210 N.Main St.,Ste.205,Clarkston,MI 48346

bottom of page