New Patient Forms
- NEW PATIENT REGISTRATION PACKET - Click on the form to download forms for your upcoming visit. Please print and fax or mail to us before your first visit.
- RECORD RELEASE TO THOUSAND OAKS PEDIATRICS - Use this form to have prior records transferred to us.
- HIPAA NOTICE OF PRIVACY PRACTICES
- HIPAA NOTICE OF PRIVACY PRACTICES - SPANISH
- CONTACT INFORMATION
Tele-medicine Form
Well Forms
Please click on the links below to download forms. Please print and bring to your next WELL CHILD VISIT.
Developmental Forms
Click on the links below to download forms for your upcoming visit. Please Print and fax or mail to us so we may schedule an appointment. If this is your first visit, please also complete the New Patient Forms above.
- ADHD RELATED FORMS - Use this questionnaire for all attention related difficulties.
- DEVELOPMENTAL FORMS - Use this questionnaire for all developmental issues other than attention problems.
- SNAP-IV QUESTIONNAIRE - This is useful for following up with teachers related to attention issues.
Office Forms
Click on the link below to download or view forms. Please Print and fax or mail to us.
- RECORD RELEASE TO THOUSAND OAKS PEDIATRICS
- RECORD RELEASE FROM THOUSAND OAKS PEDIATRICS - Please not that there is a charge of $20 for transferring records to a CD.
- PERMISSION TO AUTHORIZE CARE - Use this form to give other caretakers permission to authorize treatment of your child.
- HIPAA NOTICE OF PRIVACY PRACTICES
- HIPAA NOTICE OF PRIVACY PRACTICES - SPANISH
- CONSENT TO RECEIVE EMAILS AND TEXT MESSAGES
- FINANCIAL POLICY
- PEDIATRIC HISTORY FORM
Vaccines
Click on the links below to download or view information:
- Why we give so many vaccines so early by Dr. Kundell
- Immunization for Babies. - This is a good summary for the first two years.
- Immunization for Children and Adolescents. - This has all the basic vaccines we recommend from birth through adolescence.
- VACCINE STATEMENTS in English and other languages - These are the official forms we are required to give you at each visit.
- CDC Detailed Vaccine Schedule 0-18 years.
