{"id":2587,"date":"2022-09-09T08:14:06","date_gmt":"2022-09-09T08:14:06","guid":{"rendered":"https:\/\/www.toplinemd.com\/advanced-pediatrics-boca\/?page_id=2587"},"modified":"2025-09-30T18:56:21","modified_gmt":"2025-09-30T18:56:21","slug":"forms","status":"publish","type":"page","link":"https:\/\/www.toplinemd.com\/advanced-pediatrics-boca\/forms\/","title":{"rendered":"Forms"},"content":{"rendered":"<p><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-1 fusion-parallax-none nonhundred-percent-fullwidth non-hundred-percent-height-scrolling PC2-title-sep-section\" style=\"--awb-background-position:center bottom;--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-padding-top:5%;--awb-padding-bottom:5%;--awb-background-color:#eeeeee;--awb-background-image:linear-gradient(180deg, rgba(0,0,0,0.2) 0%,rgba(0,0,0,0.2) 100%),url(https:\/\/www.toplinemd.com\/advanced-pediatrics-boca\/wp-content\/uploads\/sites\/263\/2022\/09\/Forms-page-header.jpg);;--awb-background-size:cover;--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-0 fusion_builder_column_1_6 1_6 fusion-one-sixth fusion-column-first fusion-no-small-visibility\" style=\"--awb-bg-size:cover;--awb-margin-top:0px;--awb-margin-bottom:0px;width:16.6666666667%;width:calc(16.6666666667% - ( ( 0 + 0 ) * 0.166666666667 ) );margin-right: 0px;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-column-wrapper-legacy\"><div class=\"fusion-clearfix\"><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-1 fusion_builder_column_2_3 2_3 fusion-two-third hero-header\" style=\"--awb-bg-size:cover;--awb-margin-top:45px;--awb-margin-bottom:45px;width:66.6666666667%;width:calc(66.6666666667% - ( ( 0 + 0 ) * 0.666666666667 ) );margin-right: 0px;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-column-wrapper-legacy\"><div class=\"fusion-text fusion-text-1\"><h1 class=\"title-h2\" style=\"text-align: center; color: #fff; margin-bottom: 0;\">FORMS<\/h1>\n<\/div><div class=\"title-sep-custom\"><hr><i class=\"fa-heart fas\" style=\"color:#ffffff;\"><\/i><hr><\/div><div class=\"fusion-clearfix\"><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-2 fusion_builder_column_1_6 1_6 fusion-one-sixth fusion-column-last fusion-no-small-visibility\" style=\"--awb-bg-size:cover;--awb-margin-top:0px;--awb-margin-bottom:0px;width:16.6666666667%;width:calc(16.6666666667% - ( ( 0 + 0 ) * 0.166666666667 ) );\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-column-wrapper-legacy\"><div class=\"fusion-clearfix\"><\/div><\/div><\/div><\/div><\/div><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-2 fusion-flex-container nonhundred-percent-fullwidth non-hundred-percent-height-scrolling PC2-guarantee-sec\" style=\"--awb-background-position:right bottom;--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-padding-top:5%;--awb-padding-bottom:5%;--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-stretch fusion-flex-justify-content-center fusion-flex-content-wrap\" style=\"max-width:1248px;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-3 fusion_builder_column_1_2 1_2 fusion-flex-column fusion-animated\" style=\"--awb-bg-blend:overlay;--awb-bg-size:cover;--awb-width-large:50%;--awb-margin-top-large:15px;--awb-spacing-right-large:3.84%;--awb-margin-bottom-large:15px;--awb-spacing-left-large:3.84%;--awb-width-medium:100%;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\" data-animationType=\"zoomIn\" data-animationDuration=\"0.9\" data-animationOffset=\"top-into-view\"><div class=\"fusion-column-wrapper fusion-flex-justify-content-center fusion-content-layout-column\"><div class=\"fusion-title title fusion-title-1 fusion-title-text fusion-title-size-three\"><div class=\"title-sep-container title-sep-container-left fusion-no-large-visibility fusion-no-medium-visibility fusion-no-small-visibility\"><div class=\"title-sep sep- sep-solid\" style=\"border-color:#5e6276;\"><\/div><\/div><span class=\"awb-title-spacer fusion-no-large-visibility fusion-no-medium-visibility fusion-no-small-visibility\"><\/span><h3 class=\"fusion-title-heading title-heading-left\" style=\"margin:0;\">PATIENTS FORMS<\/h3><span class=\"awb-title-spacer\"><\/span><div class=\"title-sep-container title-sep-container-right\"><div class=\"title-sep sep- sep-solid\" style=\"border-color:#5e6276;\"><\/div><\/div><\/div><div class=\"fusion-separator\" style=\"align-self: flex-start;margin-right:auto;margin-top:5px;margin-bottom:35px;width:100%;max-width:18%;\"><div class=\"fusion-separator-border sep-single\" style=\"--awb-height:20px;--awb-amount:20px;--awb-sep-color:#008000;border-color:#008000;border-top-width:2px;\"><\/div><\/div><ul style=\"--awb-size:20px;--awb-item-padding-top:0px;--awb-item-padding-right:0px;--awb-item-padding-bottom:0px;--awb-item-padding-left:0px;--awb-iconcolor:#008000;--awb-line-height:34px;--awb-icon-width:34px;--awb-icon-height:34px;--awb-icon-margin:14px;--awb-content-margin:48px;\" class=\"fusion-checklist fusion-checklist-1 type-icons\"><li class=\"fusion-li-item\" style=\"\"><span class=\"icon-wrapper circle-no\"><i class=\"fusion-li-icon fa-file-pdf fas\" aria-hidden=\"true\"><\/i><\/span><div class=\"fusion-li-item-content\"><a href=\"\/wp-content\/uploads\/sites\/263\/2025\/09\/PATIENT-REGISTRATION-2025.pdf\" target=\"_blank\" rel=\"noopener\">New registration packet<\/a><\/div><\/li><li class=\"fusion-li-item\" style=\"\"><span class=\"icon-wrapper circle-no\"><i class=\"fusion-li-icon fa-file-pdf fas\" aria-hidden=\"true\"><\/i><\/span><div class=\"fusion-li-item-content\">\n<p><a href=\"\/advanced-pediatrics-boca\/wp-content\/uploads\/sites\/263\/2022\/09\/Release-of-medical-records-new.pdf\" target=\"_blank\" rel=\"noopener\">Release of medical records<\/a><\/p>\n<\/div><\/li><li class=\"fusion-li-item\" style=\"\"><span class=\"icon-wrapper circle-no\"><i class=\"fusion-li-icon fa-file-pdf fas\" aria-hidden=\"true\"><\/i><\/span><div class=\"fusion-li-item-content\">\n<p><a href=\"\/advanced-pediatrics-boca\/wp-content\/uploads\/sites\/263\/2022\/09\/Acquisition-of-medical-records-new.pdf\" target=\"_blank\" rel=\"noopener\">Acquisition of medical records<\/a><\/p>\n<\/div><\/li><\/ul><\/div><\/div><\/div><\/div><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-3 nonhundred-percent-fullwidth non-hundred-percent-height-scrolling fusion-equal-height-columns PC2-request-sec\" style=\"--awb-background-position:right top;--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-padding-top:5%;--awb-padding-bottom:5%;--awb-background-color:#2f66af;--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-4 fusion_builder_column_1_1 1_1 fusion-one-full fusion-column-first fusion-column-last fusion-animated\" style=\"--awb-padding-top:2%;--awb-bg-blend:overlay;--awb-bg-size:cover;\" data-animationType=\"zoomIn\" data-animationDuration=\"1.0\" data-animationOffset=\"top-into-view\"><div class=\"fusion-column-wrapper fusion-flex-column-wrapper-legacy\"><div class=\"fusion-column-content-centered\"><div class=\"fusion-column-content\"><div class=\"fusion-title title fusion-title-2 fusion-sep-none fusion-title-text fusion-title-size-three\" style=\"--awb-margin-top:0px;--awb-margin-bottom:0px;\"><h3 class=\"fusion-title-heading title-heading-left\" style=\"margin:0;\"><p style=\"text-align: center;\"><span style=\"color: #ffffff;\">CONTACT INFORMATION<\/span><\/p><\/h3><\/div><div class=\"fusion-sep-clear\"><\/div><div class=\"fusion-separator\" style=\"margin-left: auto;margin-right: auto;margin-top:35px;margin-bottom:35px;width:100%;max-width:25%;\"><div class=\"fusion-separator-border sep-single sep-solid\" style=\"--awb-height:20px;--awb-amount:20px;--awb-sep-color:#ffffff;border-color:#ffffff;border-top-width:2px;\"><\/div><\/div><div class=\"fusion-sep-clear\"><\/div><div class=\"fusion-text fusion-text-2\"><p style=\"color: #ffffff; text-align: center;\">Interested in scheduling an appointment with one of our providers?<\/p>\n<\/div><div class=\"fusion-aligncenter\"><a class=\"fusion-button button-flat button-large button-custom fusion-button-default button-1 fusion-button-span-no fusion-button-default-type PC2-big-btn\" style=\"--button_accent_color:#2f66af;--button_border_color:#2f66af;--button_accent_hover_color:#ffffff;--button_border_hover_color:#333645;--button_gradient_top_color:#ffffff;--button_gradient_bottom_color:#ffffff;--button_gradient_top_color_hover:#ffa500;--button_gradient_bottom_color_hover:#ffa500;\" target=\"_self\" href=\"tel:+15614871616\"><span class=\"fusion-button-text awb-button__text awb-button__text--default\">CALL NOW<\/span><\/a><\/div><\/div><\/div><div class=\"fusion-clearfix\"><\/div><\/div><\/div><\/div><\/div>\n<div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-4 fusion-flex-container hundred-percent-fullwidth non-hundred-percent-height-scrolling prim-care2-logos-footer\" style=\"--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-padding-top:30px;--awb-padding-right:20px;--awb-padding-bottom:30px;--awb-padding-left:20px;--awb-background-color:#f0f3f6;--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-center fusion-flex-justify-content-space-between fusion-flex-content-wrap\" style=\"width:calc( 100% + 0px ) !important;max-width:calc( 100% + 0px ) !important;margin-left: calc(-0px \/ 2 );margin-right: calc(-0px \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-5 fusion_builder_column_1_2 1_2 fusion-flex-column logo-footer\" style=\"--awb-padding-top:40px;--awb-padding-left:20px;--awb-padding-left-medium:0px;--awb-padding-left-small:0px;--awb-bg-size:cover;--awb-width-large:50%;--awb-margin-top-large:15px;--awb-spacing-right-large:0px;--awb-margin-bottom-large:15px;--awb-spacing-left-large:0px;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:0px;--awb-spacing-left-medium:0px;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:0px;--awb-spacing-left-small:0px;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-image-element md-text-align-center sm-text-align-center\" style=\"text-align:left;--awb-max-width:270px;--awb-caption-title-font-family:var(--h2_typography-font-family);--awb-caption-title-font-weight:var(--h2_typography-font-weight);--awb-caption-title-font-style:var(--h2_typography-font-style);--awb-caption-title-size:var(--h2_typography-font-size);--awb-caption-title-transform:var(--h2_typography-text-transform);--awb-caption-title-line-height:var(--h2_typography-line-height);--awb-caption-title-letter-spacing:var(--h2_typography-letter-spacing);\"><span class=\" fusion-imageframe imageframe-none imageframe-1 hover-type-none\"><a class=\"fusion-no-lightbox\" href=\"\/advanced-pediatrics-boca\/\" target=\"_self\" aria-label=\"advanced-pediatrics-of-boca-horizontal\"><img decoding=\"async\" width=\"270\" height=\"100\" src=\"https:\/\/www.toplinemd.com\/advanced-pediatrics-boca\/wp-content\/uploads\/sites\/263\/2022\/08\/advanced-pediatrics-of-boca-horizontal.png\" alt class=\"img-responsive wp-image-2558\" srcset=\"https:\/\/www.toplinemd.com\/advanced-pediatrics-boca\/wp-content\/uploads\/sites\/263\/2022\/08\/advanced-pediatrics-of-boca-horizontal-200x74.png 200w, https:\/\/www.toplinemd.com\/advanced-pediatrics-boca\/wp-content\/uploads\/sites\/263\/2022\/08\/advanced-pediatrics-of-boca-horizontal.png 270w\" sizes=\"(max-width: 1024px) 100vw, (max-width: 640px) 100vw, 270px\" \/><\/a><\/span><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-6 fusion_builder_column_1_2 1_2 fusion-flex-column logo-footer\" style=\"--awb-padding-top:40px;--awb-padding-right:40px;--awb-padding-right-medium:0px;--awb-padding-right-small:0px;--awb-bg-size:cover;--awb-width-large:50%;--awb-margin-top-large:15px;--awb-spacing-right-large:0px;--awb-margin-bottom-large:15px;--awb-spacing-left-large:0px;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:0px;--awb-spacing-left-medium:0px;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:0px;--awb-spacing-left-small:0px;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-image-element md-text-align-center sm-text-align-center\" style=\"text-align:right;--awb-max-width:270px;--awb-caption-title-font-family:var(--h2_typography-font-family);--awb-caption-title-font-weight:var(--h2_typography-font-weight);--awb-caption-title-font-style:var(--h2_typography-font-style);--awb-caption-title-size:var(--h2_typography-font-size);--awb-caption-title-transform:var(--h2_typography-text-transform);--awb-caption-title-line-height:var(--h2_typography-line-height);--awb-caption-title-letter-spacing:var(--h2_typography-letter-spacing);\"><span class=\" fusion-imageframe imageframe-none imageframe-2 hover-type-none\"><a class=\"fusion-no-lightbox\" href=\"https:\/\/www.toplinemd.com\/why-topline-md\/\" target=\"_blank\" aria-label=\"topline-corporate-logo\" rel=\"noopener noreferrer\"><img decoding=\"async\" width=\"740\" height=\"175\" src=\"https:\/\/www.toplinemd.com\/wp-content\/uploads\/sites\/263\/2020\/03\/topline-corporate-logo.png\" alt class=\"img-responsive wp-image-2240\" 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\/><\/a><\/span><\/div><\/div><\/div><\/div><\/div>\n<\/p>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":3,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"100-width.php","meta":{"footnotes":"","_links_to":"","_links_to_target":""},"class_list":["post-2587","page","type-page","status-publish","hentry"],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/www.toplinemd.com\/advanced-pediatrics-boca\/wp-json\/wp\/v2\/pages\/2587","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.toplinemd.com\/advanced-pediatrics-boca\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.toplinemd.com\/advanced-pediatrics-boca\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.toplinemd.com\/advanced-pediatrics-boca\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/www.toplinemd.com\/advanced-pediatrics-boca\/wp-json\/wp\/v2\/comments?post=2587"}],"version-history":[{"count":0,"href":"https:\/\/www.toplinemd.com\/advanced-pediatrics-boca\/wp-json\/wp\/v2\/pages\/2587\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.toplinemd.com\/advanced-pediatrics-boca\/wp-json\/wp\/v2\/media?parent=2587"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}