Forms

New patient forms may be returned in one of the following ways:

•    Fax: 1.928.214.3601

•    Email: Please call our office for an encrypted link to reply to

•    Paper copies (print & bring completed forms to your first appointment)

• AAP New Patient Questionnaire (PDF)
• HIPAA Privacy (PDF)
• Consent for Authorized Persons (PDF)
• Telehealth Consent (PDF)
• Vaccines for Children (VFC) Eligibility (PDF)
• Financial Policy (PDF)
• Court and Hearing Consent (PDF)

Mountain View Pediatrics standardly releases 1 complimentary set of the most recent 2 years of medical data.

If you are requesting additional information or an extended time frame, please specify below in the additional comments section.

A $15 fee may be applied outside of the standards above. 

• Record Request (PDF)

• 25-26 Sports Physical
• 2025-2026 AIA Sport Physical Form - Please complete parent and athlete portions before your visit. Thank you.

• 2021-2022 Mild Traumatic Brain Injury (MTBI) / Concussion Acknowledgement Form (PDF)
• M-CHAT (PDF)