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Policies & Forms

Welcome to our policies and forms page. Here you can easily view and fill out any necessary documents and return them to us. We strive to make the process as simple and convenient as possible for you. Please let us know if you have any questions or concerns.

New Patient Agreement

Our patient agreement includes all the necessary forms and information to get you started with our practice. Please fill out the forms completely and return them to us at your earliest convenience. If you have any questions or concerns, please don't hesitate to reach out!

Authorization to Release Health Information

Our Authorization to Release Health Information form allows you to authorize the release of your health information to a healthcare provider, family member, or school for coordination of care. This form includes the transfer of your health information from your current healthcare provider to the recipient, as well as the sharing of your health information with family or schools. 

Family History Form

The family history form can help us identify potential health risks and develop personalized prevention and treatment plans. The form includes questions about the patient's immediate family members, such as parents siblings, and grandparents, well as their medical history. It is important to fill out this form accurately and completely to ensure the best possible care.

Vaccination Policy

Red Clover Pediatrics has a vaccination policy that we adhere to for the safety of our patients and community which can be accessed below. 

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