New Patient Forms

The Milford Pediatric Group offers patient forms you can fill out online from the convenience of your home or office. Click on the necessary form(s) below and upon completion, click "Submit".

General Practice Forms

Patient Information Form:
Downloadable PDF
Online Form
Patient Over 18 Years Old Information Form:
Downloadable PDF
Online Form
Patient Directed Release Form:
Downloadable PDF
Online Form
No Show Policy:
Please see our office policy for no showing appointments.
  • First Missed Appointment: A $25 charge and a letter outlining our policy
  • Second Missed Appointment: A $50 charge
  • Third missed Appointment: You will be discharged from our practice
If there is a missed appointment fee on your account it must be paid in full prior to scheduling any new appointments.

School Physical Forms

Early Childhood Health Assessment Record (ED 191)
Downloadable PDF
Health Assessment Record (HAR-3)
Downloadable PDF
Authorization for Administration of Medication Form
Downloadable PDF

HIPAA Forms

HIPAA Authorization Form for Over 18 Years Old:
Downloadable PDF
Online Form
HIPAA Authorization Form for Parents/Guardians:
Downloadable PDF
Online Form

Sports Forms

Pop Warner Physical Fitness & Medical History Form
Downloadable PDF
Read Our Patient Testimonials

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