Patient Forms

We encourage you to print, complete, and return the following forms before your child's first visit:

• Telemedicine Consent Form
• Patient Information Form
• Past Medical History Form
• Medical Record Release Form
• Patient Eligibility Screening Record Vaccines for Children Program
• Consent to Share Information with Parents (18 year olds)
• Unaccompanied Child Authorization (Ages 16-18 years)
• Secondary Insurance

Return Your Forms

Fax

(623) 362-8095

E-Mail

administrator@valleyofthesunpediatrics.com

Mail

Valley of the Sun Pediatrics
10200 West Happy Valley Parkway, Suite 125
Peoria, AZ 85383