Forms Library
When you register at Northampton Area Pediatrics, it is useful to have completed these forms prior to your child's first appointment. We also can provide copies of these forms for you when you arrive at the office.
- Patient Information
- This form contains basic demographic information for your family: names, address(es), phone numbers, and emergency contacts.
- Patient Eligibility
- This form determines whether your child is eligible for the state vaccine program.
- Family Medical History
- This form contains a list of medical conditions and diagnoses that are important to the health of your child. Please indicate whether any family members have these diagnoses.
- Preparticipation Evaluation
- This form should be completed by teenagers who will be participating in school sports.
- TB/Lead Risk Assessment
- This set of questions assesses your child's risk of exposure to lead or tuberculosis.
