New Patient Information Session
New Patient 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)
Record Requests
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.
Sports Physicals
2025-2026 AIA Sport Physical Form - Please complete parent and athlete portions before your visit. Thank you.
Additional Forms
Deciding who your new baby's pediatrician will be shouldn't be a guessing a game. We feel that a strong bond is formed between you, your child and your doctor. This is why we offer an invitation to prospective and new parents to view our practice virtually and even schedule time with a provider for additional questions.
Our New Patient Information Sessions are designed for YOU. We have tried to cover most of our new patient FAQ's in this video and hope you are able to become familiar with who we are and what we can offer. Please watch the video below with anyone you want to include in your child's care such as spouses, partners, grandparents, friends or just yourself. There is never an obligation, and we actively encourage you to visit the other pediatricians in Flagstaff to make the right choice for your family.
If you have questions beyond our video, want to register a new patient or need any additional assistance, please call our office #928-214-3600.
