New Patient Forms

Thank you for choosing Middleton Pediatrics as your child's medical home, where we always provide a comfortable, caring environment so our patients and their families can feel at ease. We've included helpful items on this page to ensure you and your child's first trip to our office is productive, stress-free and enjoyable.

Our Mission

Our practice is working together to build life-long relationships between our staff and our patients by consistently providing our patients with compassion, excellence and value. To fulfill this mission, we are committed to:

  • Improving the lives of the children we serve by providing quality care in a child-centered environment.
  • Listening to our young patients and their families who we are privileged to serve.
  • Guiding our patients along a path of optimal health and wellness.
  • Continually pursuing excellence at all levels through continuing education.

If you're preparing for your child's first visit, you can do a few things to help expedite the appointment. Please provide the following information when you arrive for your visit:

  • Insurance cards
  • Complete immunization records
  • Medical records from your previous pediatrician

Patient Forms

To request a copy of your child’s records, or to have your child’s records transferred, please contact kelli@middletonpediatrics.com to obtain our Records Release Authorization Form.

Asthma and Food Allergy Plans

Please print the appropriate forms if your child suffers from Asthma and/or Food Allergies, and bring the forms to your next appointment to complete them with your provider.  These forms are for use at home or at your child’s school in the event of an emergency.

ADHD Forms

Please print and complete the appropriate forms before your ADHD/Behavior consultation.

In order to view or print these forms you will need Adobe Acrobat Reader installed. Click here to download it.

 

Directions

Contact Us

Office Hours
Monday:8:15 AM - 5:00 PM
Tuesday:8:15 AM - 5:00 PM
Wednesday:8:15 AM - 5:00 PM
Thursday:8:15 AM - 5:00 PM
Friday:8:15 AM - 5:00 PM
Saturday:Closed
Sunday:Closed