Forms

NOTE: Please bring any preschool, school, camp, sports or college forms with you to your child’s well exams and we will fill them out at that time.  If you are dropping off these types of forms at our office, please note there is $10 processing fee for filling these forms.  Please drop off and pick up all forms, medical records or immunization cards at our main office Suite B105.  Please read Medical Records and also Immunization Records, Forms and Letters for more information.

For Medical Transfer Forms, original signatures are required.
Faxed copies will not suffice.

New Patients
Complete the following forms to save time on your first visit to the office
Description
pdf Patient Information Sheet
pdf Transfer of Records to ECP
Subspecialists
Description
pdf Transfer of Records from ECP
Leaving ECP
Description
pdf Transfer of Records from ECP
Screening Forms
Description
pdf Asthma Screening
pdf Child Attention Profile
pdf Flu Vaccine Release Form
pdf Pain Diary
pdf Postpartum Depression Self-Assessment (see Postpartum Health Alliance for local resources)
Childcare and School Forms
pdf San Diego County School Entry Form (kindergarten/1st grade school form)
pdf Child Care Center Pre-Admission Health Form
 Insurance
pdf
 Print new insurance information form to fill in and fax to office
doc
 Download new insurance information form for electronic completion to email to office