New Patient Forms

Consent to Disclose PHI for 18 yr old pts

(for patient's 18 or older)

Patient Registration Packet

Completed forms can be sent ahead of scheduled appointment to medicalrecords@camelbackpeds.com

Telemedicine Consent Form

(NOTE: To sign digitally, you must open the document in a PDF application, complete, sign and email back to us. Optionally, you can print, complete, scan and return via email.)

Medical Records Release - Incoming Records

Consent by Proxy for Non-Urgent Care