New Patient Packet

Please complete the following forms and either fax or mail to our office along with a copy of your current insurance card.

• Demographic Information
• Office Financial Policy
• HIPPA Patient Consent Form
  • Dublin Patients
    • Privacy Practices
    • HIPPA Consent
  • New Albany Patients
    • Privacy Practices
    • HIPPA Consent
• Records Release; Please print, complete and forward to your child’s previous physician prior to your first appointment in our office (if possible).

Annual Demographic Information Update

Please print, complete and bring with you to your child’s annual preventative exam.

• Demographic Update
• Office Financial Policy

Daycare Forms

• Childs Medical Statement
• Medication Authorization

Athletic Forms

Upon entering 7th grade most schools require annual completion of this form for all students participating in sports. Please print, complete the entire first page and then bring both pages with you to your child's annual preventative exam for the provider to review and complete.

• High School Athletic Form

Release Forms

• Permission to Fax
• Transferring out of Rainbow Pediatrics
• Permission to evaluate minor child

Neuropsychologicy forms

• Teacher Assessments
• Parent Assessments
• Teacher Follow Up Assessments
• Parent Follow Up Assessments