Forms & Policies

If you are new to our practice, prior to your visit, call us and we’ll ask for your email address and quickly register you in our secure electronical medical records system. Please know that we’ve invested in technology to make your first experience with us as streamlined as possible. To save you time and ensure greater accuracy, we utilize a completely secure electronic registration and check-in solution (click on this link to learn more). The forms below are provided for your reference however, you will be able to read them online when we send you an email to check-in online before your visit.

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WARNING: Filling out the form in the browser will not save the data. The PDF must be opened and filled out in Acrobat, and if using the free Acrobat Reader, must be saved in this method.

Family Medical History
Financial Policy
Office Policies
Notice of Privacy Practices
Authorization for Use and Disclosure of Personal Health Information (PHI)
Fees for Forms and Medical Records
Medical Records Release Form (Incoming or Outgoing)
A Patient's Guide to Understanding Health Insurance Coverage and Payment Practices
Office Hours, Addresses, Telephone and Fax Numbers
Over 18 Patient Responsibility Agreement


ADHD Vanderbilt Forms Package
ADHD Vanderbilt Initial Parent Evaluation Forms
ADHD Vanderbilt Initial Teacher Evaluation Forms
ADHD Vanderbilt Parent/Teacher Follow-Up Forms

School Physical Forms

Tri-County Pediatrics

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Business Office: 1939 Cheltenham Avenue, Elkins Park, PA 19027 Offices: See All Locations Email: info@tricountypeds.com

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