If you are new to our practice, please fill out the "new patient" and "records release" forms before coming to your first appointment.
For school or sports forms, please remember to bring them with you to your child's well child appointment. If forms are brought in at other times, there is a fee of $20 to complete the forms. We take extra time to carefully review your child's health history to fill out these forms. Please give us 3-5 days turn around time for these forms.
Magnolia Pediatric Registration Form (PDF)
UBCP MPM Privacy Form (PDF)
My Chart Proxy 0-11 yrs (PDF)
My Chart Adolescent Proxy 12-17 yrs (PDF)
Releasing Information to Parents Tipsheet (PDF)
Medical Records Release (PDF)