PATIENT FORMS

Want to save time during your visit with us? Please print and fill out the following forms and bring with you to your first appointment.

Medical Records Release
Auth for release of records .pdf
Adobe Acrobat document [334.6 KB]
Patient Registration Form
Patient Registration-Premier.pdf
Adobe Acrobat document [180.0 KB]
Payment Policy
Payment Policy- PP.pdf
Adobe Acrobat document [302.9 KB]
Privacy Practices Acknowledgment Form
Privacy Practices Acknowledgment form-PP[...]
Adobe Acrobat document [192.1 KB]
Pediatric Health History - Infant
Pediatric Health History INFANT PP.pdf
Adobe Acrobat document [231.8 KB]
Pediatric Health History - Child
Pediatric Health History Child -Premier.[...]
Adobe Acrobat document [200.8 KB]
Notice of Privacy Practices
Notice of Privacy Practices-PP.pdf
Adobe Acrobat document [429.8 KB]
No Show Policy Acknowledgement Form
No show Policy 2017 on letterhead.pdf
Adobe Acrobat document [354.8 KB]
Consent to Medical Treatment Form
Consent Document.pdf
Adobe Acrobat document [245.5 KB]
ADHD Vanderbilt Parent Form
Vanderbilt Parent.pdf
Adobe Acrobat document [72.5 KB]
ADHD Vanderbilt Teacher Form
Vanderbilt Teacher.pdf
Adobe Acrobat document [70.7 KB]

Don't forget to bring your insurance information with you!

In order to register and treat you promptly, we request that our patients bring their current insurance information with them for each visit.

We accept most types of health insurance. Please contact us for further details.

Important telephone numbers for in case of emergencies:

Premier Pediatrics 561-469-8989
Emergency Services & Fire Department 911
Centers for Disease Control and Prevention 800-CDC-INFO (800-232-4636)
Poison Control 1-800-222-1222
   

Premier Pediatrics

224 Chimney Corner Lane, Suite 2032

Jupiter, FL 33458

 

(Located on the 2nd floor of the Greenwich Professional Building of Abacoa)

 

Phone: 561-469-8989

Fax: 561-469-8988

Office Hours

Monday - Friday

8:30 am - 5:00 pm


Connect With Us

Serving the children of Jupiter, Palm Beach Gardens, North Palm Beach, Tequesta, West Palm Beach

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© Premier Pediatrics | 224 Chimney Corner Lane | Jupiter, FL 33458 | www.MyPremierPediatrics.com