Healthy Steps Pediatrics Patient Forms

Below are links to our patient forms to be completed prior to your visit in our office. All Healthy Steps Pediatrics Patient Forms are fillable online from a computer. To complete them online, click on the appropriate link below. The form(s) will open in a new window where you will be able to type your information directly onto the form. Once you have filled them out completely, save them to your computer. Please use the patient’s name or your family’s last name when saving the forms.

PLEASE NOTE: if your child is a newborn and has never been seen at our practice before, please complete the NEWBORN PATIENT FORMS.

All others must complete 1 DEMOGRAPHICS FORM per child, and 1 set of FAMILY FORMS per family. This includes new patients that have never been seen at our practice.

2022 Patient Demographics Formplease fill out this form for each child seen in our office

2022 Family Formsplease fill out one set of these forms for all children seen in our office, in the same family

Newborn Patient Forms please use these forms for all newborn patients

Once complete, you may email the forms to our office at SCHEDULING@PEDIATRICS4U.COM, or you can print them off and bring them with you to your appointment. If you email the forms to us, PLEASE BE SURE TO INCLUDE A COPY (FRONT AND BACK) OF THE PATIENT’S INSURANCE CARD AND STATE ISSUED PHOTO ID (i.e. DRIVER’S LICENSE) OF BOTH PARENTS/LEGAL GUARDIANS.