Pediatricians in Harford County, MD

Bel Air - North Park - Patient Forms

Welcome to our Harford County pediatric practice!

Whether you are a new or existing pediatric patient, this section is designed to provide information on how to do business with Pediatric Partners in Bel Air.

	New Pediatric Patients		Existing Pediatric Patients
	For your convenience the following forms are available for printing and completion. To reduce the paperwork required during your first pediatrician visit, you can fill out the forms below and bring them with you to your first pediatrician appointment.		If you are an existing patient, please make sure that you provide your most current contact and insurance information during your next pediatrician visit. You can update your information using the following forms:
	Prior to your first visit at Pediatric Partners, please complete the following forms:		Registration
	Registration		Financial Policy Beneficiary Agreement
	Financial Policy Beneficiary Agreement		Parent Contact Information ADD - Home Evaluation Form
	Initial History Questionnaire - Pages 1 & 2		Record Release to another Physician Parent Authorization To Treat A Minor
	Parent Contact Information
	Release of Patients Medical Records to Pediatric Partners
	Patient's HIPAA Acknowledgment
	Please read and familiarize yourself with the following:
	Notice of Privacy Practices Patient’s HIPAA Acknowledgment (bring to your first visit) Office Policies

A Trusted Pediatrics Practice Serving Maryland Residents in Harford County, Baltimore County, Howard County, and Ellicott City.