Packets

We are excited to meet and care for your child/children! Below, you will find complete packets and individual forms based on your needs. So, whether you are trying to establish care at our clinic or updating your child’s current information, the links below will allow you to download the forms to fill out at your convenience! *Please note - we will need the forms completed for new patients prior to scheduling an appointment so we may obtain immunization records and prior medical history to best care for your child!

If you are looking to enroll one child, please select the “First Child Packet” to download and print a single copy. For every additional child you will need to print each of them a copy of the “Additional Child Packet”. You do not have to download the second packet multiple times. In the print options, change the copy amount to meet your needs!

In the first child packet, the first 2 pages are for a single child.

If you have multiple children, every child can be listed on the following forms!

The additional child packet will only have the first two pages and must be filled out entirely for each child.

Their name should be on remaining forms in the first child packet.

NEWBORNS

Congratulations on the new addition to your family! We are honored that you trust us with caring for your baby.

We know this time can be just as confusing as it is exciting, so here are a few things to keep in mind when you call to schedule your baby’s first appointment!

P.S. You can call us before the paperwork is filled out or picked up!

Quad Cities Pediatrics | Infant Pediatric Care
Quad Cities Pediatrics | Infant Pediatric Care
  • When you have a discharge date

  • With Baby’s name, date of birth, and birth weight

  • With the hospital name and planned insurance name

  • Whether you plan to bottle or breast feed (Fed is BEST)

  • With Guardian’s and/or Birth Mom’s information

Call Us When and With:

Quad Cities Pediatrics | Infant Pediatric Care
Quad Cities Pediatrics | Infant Pediatric Care

Individual Forms

Please download the forms you need to update. You will need to print, fill out to completion, and bring to your next appointment.