Northpoint Pediatrics
Forms
NORTHPOINT FORMS
This section contains various forms for your child's healthcare, from treatment authorization to release of records forms.
Learn More about getting forms to the office using email or uploading the form.
- Benefit Verification Worksheet
- Patient Registration Form
- Patient Medical History Form
- Release of Records - Incoming
- Release of Records - Outgoing
- 18-Year-and-Older Patients - Authorization for Release of Protected Health Information
Fax: 317.621.9190
Email: [email protected]
ATHLETIC | CAMP | DAYCARE FORMS
Health forms require reporting current health information, meaning your child or teen must have had a wellness exam within the last 12 months. The exception is the Boy Scouts, which require a wellness exam within 12 months before the camp date your child is attending.
We offer common local athletic, camp, and daycare forms below for your convenience. Please download, print, and bring with you for your child's examination.
Learn More about getting forms to the office using email or uploading the form.
