{"id":1834,"date":"2025-04-01T09:34:22","date_gmt":"2025-04-01T14:34:22","guid":{"rendered":"https:\/\/www.toplinemd.com\/pediatric-pros\/?page_id=1834"},"modified":"2026-05-13T21:59:09","modified_gmt":"2026-05-14T02:59:09","slug":"office-forms-and-policies","status":"publish","type":"page","link":"https:\/\/www.toplinemd.com\/pediatric-pros\/office-forms-and-policies\/","title":{"rendered":"Office Forms and Policies"},"content":{"rendered":"<p><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-1 fusion-flex-container fusion-parallax-none nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--awb-background-position:right center;--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-min-height:400px;--awb-background-image:url(&quot;https:\/\/www.toplinemd.com\/pediatric-pros\/wp-content\/uploads\/sites\/120\/2020\/11\/Registration-Forms-Header-background.jpg&quot;);--awb-background-size:cover;--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-center fusion-flex-justify-content-center fusion-flex-content-wrap\" style=\"max-width:1216.8px;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-0 fusion_builder_column_1_2 1_2 fusion-flex-column\" style=\"--awb-padding-top:20px;--awb-padding-bottom:20px;--awb-bg-color:rgba(54,180,229,0.4);--awb-bg-color-hover:rgba(54,180,229,0.4);--awb-bg-size:cover;--awb-width-large:50%;--awb-margin-top-large:0px;--awb-spacing-right-large:3.84%;--awb-margin-bottom-large:0px;--awb-spacing-left-large:3.84%;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-title title fusion-title-1 fusion-title-center fusion-title-text fusion-title-size-one fusion-animated\" style=\"--awb-margin-top-small:0px;--awb-margin-right-small:0px;--awb-margin-bottom-small:20px;--awb-margin-left-small:0px;--awb-font-size:40px;\" data-animationType=\"fadeInUp\" data-animationDuration=\"0.5\" data-animationOffset=\"top-into-view\"><div class=\"title-sep-container title-sep-container-left\"><div class=\"title-sep sep- sep-solid\" style=\"border-color:#e0dede;\"><\/div><\/div><span class=\"awb-title-spacer\"><\/span><h1 class=\"fusion-title-heading title-heading-center fusion-responsive-typography-calculated\" style=\"margin:0;text-transform:uppercase;font-size:1em;--fontSize:40;line-height:1.15;\">Office Forms and Policies<\/h1><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:#e0dede;\"><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-2 fusion-flex-container has-pattern-background has-mask-background nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" 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-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-flex-start fusion-flex-content-wrap\" style=\"max-width:1216.8px;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-1 fusion_builder_column_1_1 1_1 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:100%;--awb-margin-top-large:0px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-separator fusion-full-width-sep\" style=\"align-self: center;margin-left: auto;margin-right: auto;margin-bottom:15px;width:100%;\"><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-2 fusion_builder_column_1_1 1_1 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:100%;--awb-margin-top-large:0px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><ul style=\"--awb-size:20px;--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 fusion-checklist-default type-icons\"><li class=\"fusion-li-item\" style=\"\"><span class=\"icon-wrapper circle-no\"><i class=\"fusion-li-icon fa-angle-double-right fas\" aria-hidden=\"true\"><\/i><\/span><div class=\"fusion-li-item-content\">\n<p><a href=\"\/pediatric-pros\/wp-content\/uploads\/sites\/120\/2020\/12\/PATIENT-INFORMATION-SHEET1-Pediatric-Pros.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Patient Information Sheet<\/a><\/p>\n<\/div><\/li><li class=\"fusion-li-item\" style=\"\"><span class=\"icon-wrapper circle-no\"><i class=\"fusion-li-icon fa-angle-double-right fas\" aria-hidden=\"true\"><\/i><\/span><div class=\"fusion-li-item-content\">\n<p><a href=\"https:\/\/www.toplinemd.com\/pediatric-pros\/wp-content\/uploads\/sites\/120\/2021\/03\/FINANCIAL-RESPONSIBILITY-AGREEMENT.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Financial Responsibility Agreement<\/a><\/p>\n<\/div><\/li><li class=\"fusion-li-item\" style=\"\"><span class=\"icon-wrapper circle-no\"><i class=\"fusion-li-icon fa-angle-double-right fas\" aria-hidden=\"true\"><\/i><\/span><div class=\"fusion-li-item-content\">\n<p><a href=\"\/pediatric-pros\/wp-content\/uploads\/sites\/120\/2020\/12\/Financial-Policy-for-PPA.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Financial Policy for Pediatric Professional Associates<\/a><\/p>\n<\/div><\/li><li class=\"fusion-li-item\" style=\"\"><span class=\"icon-wrapper circle-no\"><i class=\"fusion-li-icon fa-angle-double-right fas\" aria-hidden=\"true\"><\/i><\/span><div class=\"fusion-li-item-content\">\n<p><a href=\"https:\/\/www.toplinemd.com\/practice-terms-policies\/\" target=\"_blank\" rel=\"noopener\">Practice Terms and Policies<\/a><\/p>\n<\/div><\/li><li class=\"fusion-li-item\" style=\"\"><span class=\"icon-wrapper circle-no\"><i class=\"fusion-li-icon fa-angle-double-right fas\" aria-hidden=\"true\"><\/i><\/span><div class=\"fusion-li-item-content\">\n<p><a href=\"https:\/\/www.toplinemd.com\/pediatric-pros\/wp-content\/uploads\/sites\/120\/2021\/03\/Notice-of-Privacy-Practices-Acknowledgment-Form-ENGLIS1.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Acknowledgement of Receipt of Notice of Privacy Practices<\/a><\/p>\n<\/div><\/li><li class=\"fusion-li-item\" style=\"\"><span class=\"icon-wrapper circle-no\"><i class=\"fusion-li-icon fa-angle-double-right fas\" aria-hidden=\"true\"><\/i><\/span><div class=\"fusion-li-item-content\">\n<p><a href=\"\/pediatric-pros\/wp-content\/uploads\/sites\/120\/2020\/12\/Request-Medical-Records-from-Previous-Doctor-PPA.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Request Medical Records from Previous Doctor<\/a><\/p>\n<\/div><\/li><li class=\"fusion-li-item\" style=\"\"><span class=\"icon-wrapper circle-no\"><i class=\"fusion-li-icon fa-angle-double-right fas\" aria-hidden=\"true\"><\/i><\/span><div class=\"fusion-li-item-content\">\n<p><a href=\"\/wp-content\/uploads\/2025\/03\/PPA-MISSED-APPOINTMENT-POLICY_RNU91uFXDy1L5bnRP2tLaiISyf5RvPJd.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Missed Appointment Policy<\/a><\/p>\n<\/div><\/li><li class=\"fusion-li-item\" style=\"\"><span class=\"icon-wrapper circle-no\"><i class=\"fusion-li-icon fa-angle-double-right fas\" aria-hidden=\"true\"><\/i><\/span><div class=\"fusion-li-item-content\">\n<p><a href=\"https:\/\/www.toplinemd.com\/pediatric-pros\/vaccine-policy\/\">Vaccine Policy<\/a><\/p>\n<\/div><\/li><li class=\"fusion-li-item\" style=\"\"><span class=\"icon-wrapper circle-no\"><i class=\"fusion-li-icon fa-angle-double-right fas\" aria-hidden=\"true\"><\/i><\/span><div class=\"fusion-li-item-content\">\n<p><a href=\"https:\/\/www.toplinemd.com\/pediatric-pros\/wp-content\/uploads\/sites\/120\/2021\/03\/Taglines.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Notice of Nondiscrimination Taglines<\/a><\/p>\n<\/div><\/li><li class=\"fusion-li-item\" style=\"\"><span class=\"icon-wrapper circle-no\"><i class=\"fusion-li-icon fa-angle-double-right fas\" aria-hidden=\"true\"><\/i><\/span><div class=\"fusion-li-item-content\">\n<p><a href=\"https:\/\/www.toplinemd.com\/pediatric-pros\/wp-content\/uploads\/sites\/120\/2021\/03\/Notice-of-Non-Discrimination.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Notice of Non-Discrimination<\/a><\/p>\n<\/div><\/li><\/ul><div class=\"fusion-separator fusion-full-width-sep\" style=\"align-self: center;margin-left: auto;margin-right: auto;margin-bottom:10px;width:100%;\"><\/div><\/div><\/div><\/div><\/div><\/p>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":86,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":"","_links_to":"","_links_to_target":""},"class_list":["post-1834","page","type-page","status-publish","hentry"],"aioseo_notices":[],"aioseo_head":"\n\t\t<!-- All in One SEO 4.9.10 - aioseo.com -->\n\t<meta name=\"description\" content=\"Office Forms and Policies Patient Information Sheet Financial Responsibility Agreement Financial Policy for Pediatric Professional Associates Practice Terms and Policies Acknowledgement of Receipt of Notice of Privacy Practices Request Medical Records from Previous Doctor Missed Appointment Policy Vaccine Policy Notice of Nondiscrimination Taglines Notice of Non-Discrimination\" \/>\n\t<meta name=\"robots\" content=\"max-image-preview:large\" \/>\n\t<link rel=\"canonical\" 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