{"id":94,"date":"2023-01-20T19:30:01","date_gmt":"2023-01-20T19:30:01","guid":{"rendered":"https:\/\/gpmpediatrics.com\/?page_id=94"},"modified":"2023-01-31T16:06:22","modified_gmt":"2023-01-31T16:06:22","slug":"forms","status":"publish","type":"page","link":"https:\/\/gpmpediatrics.com\/forms\/","title":{"rendered":"Forms\u00a0"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"94\" class=\"elementor elementor-94\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-26c1483 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"26c1483\" data-element_type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;,&quot;shape_divider_bottom&quot;:&quot;curve&quot;,&quot;shape_divider_bottom_negative&quot;:&quot;yes&quot;,&quot;ekit_has_onepagescroll_dot&quot;:&quot;yes&quot;}\">\n\t\t\t\t\t\t\t<div class=\"elementor-background-overlay\"><\/div>\n\t\t\t\t\t\t<div class=\"elementor-shape elementor-shape-bottom\" data-negative=\"true\">\n\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" viewBox=\"0 0 1000 100\" preserveAspectRatio=\"none\">\n\t<path class=\"elementor-shape-fill\" d=\"M500,97C126.7,96.3,0.8,19.8,0,0v100l1000,0V1C1000,19.4,873.3,97.8,500,97z\"\/>\n<\/svg>\t\t<\/div>\n\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-cda87c6\" data-id=\"cda87c6\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-e16c6aa elementor-widget elementor-widget-heading\" data-id=\"e16c6aa\" data-element_type=\"widget\" data-settings=\"{&quot;ekit_we_effect_on&quot;:&quot;none&quot;}\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style>\/*! elementor - v3.20.0 - 20-03-2024 *\/\n.elementor-heading-title{padding:0;margin:0;line-height:1}.elementor-widget-heading .elementor-heading-title[class*=elementor-size-]>a{color:inherit;font-size:inherit;line-height:inherit}.elementor-widget-heading .elementor-heading-title.elementor-size-small{font-size:15px}.elementor-widget-heading .elementor-heading-title.elementor-size-medium{font-size:19px}.elementor-widget-heading .elementor-heading-title.elementor-size-large{font-size:29px}.elementor-widget-heading .elementor-heading-title.elementor-size-xl{font-size:39px}.elementor-widget-heading .elementor-heading-title.elementor-size-xxl{font-size:59px}<\/style><h2 class=\"elementor-heading-title elementor-size-default\">Forms<\/h2>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-d909dd8 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"d909dd8\" data-element_type=\"section\" data-settings=\"{&quot;ekit_has_onepagescroll_dot&quot;:&quot;yes&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-b9eab63\" data-id=\"b9eab63\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-9864ec6 elementor-widget elementor-widget-text-editor\" data-id=\"9864ec6\" data-element_type=\"widget\" data-settings=\"{&quot;ekit_we_effect_on&quot;:&quot;none&quot;}\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style>\/*! elementor - v3.20.0 - 20-03-2024 *\/\n.elementor-widget-text-editor.elementor-drop-cap-view-stacked .elementor-drop-cap{background-color:#69727d;color:#fff}.elementor-widget-text-editor.elementor-drop-cap-view-framed .elementor-drop-cap{color:#69727d;border:3px solid;background-color:transparent}.elementor-widget-text-editor:not(.elementor-drop-cap-view-default) .elementor-drop-cap{margin-top:8px}.elementor-widget-text-editor:not(.elementor-drop-cap-view-default) .elementor-drop-cap-letter{width:1em;height:1em}.elementor-widget-text-editor .elementor-drop-cap{float:left;text-align:center;line-height:1;font-size:50px}.elementor-widget-text-editor .elementor-drop-cap-letter{display:inline-block}<\/style>\t\t\t\t<p class=\"p1\">Feel free to download, print, and fill out the following forms prior to your child\u2019s visit. Just bring a printed copy at the time of your appointment to save some time.\u00a0<\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-4531dc7 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"4531dc7\" data-element_type=\"section\" data-settings=\"{&quot;ekit_has_onepagescroll_dot&quot;:&quot;yes&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-0852097\" data-id=\"0852097\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-4351ca4 elementor-widget elementor-widget-text-editor\" data-id=\"4351ca4\" data-element_type=\"widget\" data-settings=\"{&quot;ekit_we_effect_on&quot;:&quot;none&quot;}\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-5b0c935 elementor-widget elementor-widget-heading\" data-id=\"5b0c935\" data-element_type=\"widget\" data-settings=\"{\" data-widget_type=\"heading.default\"><p class=\"elementor-widget-container\"><a href=\"https:\/\/gpmpediatrics.com\/wp-content\/uploads\/2022\/10\/PATIENT-REGISTRATION-FORM.pdf\" target=\"_blank\" rel=\"noopener\">Patient Registration Form<\/a><\/p><\/div><div class=\"elementor-element elementor-element-f8c333a elementor-widget elementor-widget-heading\" data-id=\"f8c333a\" data-element_type=\"widget\" data-settings=\"{\" data-widget_type=\"heading.default\"><div class=\"elementor-widget-container\"><p class=\"elementor-heading-title elementor-size-default\"><a href=\"https:\/\/gpmpediatrics.com\/wp-content\/uploads\/2022\/10\/Patient-Insurance-Information.pdf\">Patient Insurance Information Form<\/a><\/p><p class=\"elementor-heading-title elementor-size-default\"><a href=\"https:\/\/gpmpediatrics.com\/wp-content\/uploads\/2022\/10\/Patient-History-updated-8-16.pdf\">Initial History Questionnaire<\/a><\/p><div class=\"elementor-widget-container\"><p class=\"elementor-heading-title elementor-size-default\"><a href=\"https:\/\/gpmpediatrics.com\/wp-content\/uploads\/2022\/10\/AUTHORIZATION-FOR-MEDICAL-TREATMENT-HIPAA.pdf\">Authorization for Medical Treatment<\/a><\/p><p><a href=\"https:\/\/gpmpediatrics.com\/wp-content\/uploads\/2022\/10\/Credit-Card-Authorization-Form.pdf\">Credit Card Authorization Form<\/a><\/p><\/div><p class=\"elementor-heading-title elementor-size-default\"><a href=\"https:\/\/gpmpediatrics.com\/wp-content\/uploads\/2022\/10\/RECORDS-RELEASE-AUTHORIZATION.pdf\">Records Release Authorization Form<\/a><\/p><p class=\"elementor-heading-title elementor-size-default\"><a href=\"https:\/\/gpmpediatrics.com\/wp-content\/uploads\/2022\/10\/OUTGOING-RECORDS-RELEASE-AUTHORIZATION.pdf\">Records Release Authorization Form \u2013 Outgoing<\/a><\/p><p class=\"elementor-heading-title elementor-size-default\"><a href=\"https:\/\/gpmpediatrics.com\/wp-content\/uploads\/2022\/10\/Over-18-Authorization.pdf\">Over 18 Authorization<\/a><\/p><p class=\"elementor-heading-title elementor-size-default\"><a href=\"https:\/\/gpmpediatrics.com\/wp-content\/uploads\/2022\/10\/GPM-_Authorization_to_use_photos.pdf\">GPM Photo Authorization<\/a><\/p><p class=\"elementor-heading-title elementor-size-default\"><a href=\"https:\/\/gpmpediatrics.com\/wp-content\/uploads\/2022\/10\/nyu-hie_20180220152442.pdf\">NYU HIE Consent Form<\/a><\/p><p><a href=\"https:\/\/gpmpediatrics.com\/wp-content\/uploads\/2022\/10\/Financial-Policy.pdf\">Financial Policy<\/a><\/p><p class=\"elementor-heading-title elementor-size-default\"><a href=\"https:\/\/gpmpediatrics.com\/wp-content\/uploads\/2022\/10\/NOTICE-OF-PRIVACY-updated-2015.pdf\">Notice of Privacy (for review purposes only \u2013 you do not need to bring this form with you)<\/a><\/p><\/div><\/div>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-30b9444\" data-id=\"30b9444\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Forms Feel free to download, print, and fill out the following forms prior to your child\u2019s visit. Just bring a printed copy at the time of your appointment to save some time.\u00a0 Patient Registration Form Patient Insurance Information Form Initial History Questionnaire Authorization for Medical Treatment Credit Card Authorization Form Records Release Authorization Form Records [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"elementor_header_footer","meta":{"footnotes":""},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v22.3 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Forms\u00a0 - GPM Pediatrics<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/gpmpediatrics.com\/forms\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Forms\u00a0 - GPM Pediatrics\" \/>\n<meta property=\"og:description\" content=\"Forms Feel free to download, print, and fill out the following forms prior to your child\u2019s visit. 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