Pediatric Associates Urgent Care

We provide the best care seven days a week.

Home Office Forms

Office Forms

We are currently working on making all our forms available to download from our website.

Consent to Treat Form:

A parent or legal guardian must accompany each child to his/her appointment. This form must be completed and on file with our office if an alternate caregiver will be bringing your child in for treatment.
DOWNLOAD: Consent to Treat

Walk-In Form:

For non-active patients, we ask that you download, complete and print these forms out prior to your visit.
DOWNLOAD: Walk-In Form

Wellness Visit Forms:

Please see the applicable forms for your child’s upcoming well visit. Please download, complete and bring to your visit.

NEWBORN VISIT
Patient Registration Form
DOWNLOAD: EPDS screening

9 MONTH VISIT
DOWNLOAD: AgesStages9Month

18 MONTH VISIT
DOWNLOAD: AgesStages18Month
DOWNLOAD: MCHAT

2 YEAR VISIT
DOWNLOAD: MCHAT

3 YEAR VISIT
DOWNLOAD: AgesStages36Month
DOWNLOAD: ASQ36month

Physical Forms:

Please download, complete parent portion and bring to your visit.
DOWNLOAD: School_Daycare Physical
DOWNLOAD: Sports Physical

Medical Release Form:

If you are a new patient and need to request that your old office sends us a complete set of your child’s medicals records, please complete and submit to our office.
DOWNLOAD: Medical release form – Coming

If you are an active patient relocating to another office, please complete the following form and submit to our office.
DOWNLOAD: Medical release form – Leaving

Urgent Care Hours:

Urgent Care hours are available to our entire pediatric community! Urgent Care is available at Evergreen Park ONLY!
Monday & Thursday 9AM – 9PM
Tuesdays, Wednesdays & Fridays 9AM – 5PM
Saturday 10AM – 3PM

Please Call!

We do not treat life threatening emergencies.
Please call 911 or report to nearest emergency room.

(844) 372-7672