{"id":1078,"date":"2021-08-02T08:53:33","date_gmt":"2021-08-02T08:53:33","guid":{"rendered":"https:\/\/www.toplinemd.com\/vip-pediatrics\/?page_id=1078"},"modified":"2021-09-15T10:04:58","modified_gmt":"2021-09-15T10:04:58","slug":"new-patient-forms","status":"publish","type":"page","link":"https:\/\/www.toplinemd.com\/vip-pediatrics\/new-patient-forms\/","title":{"rendered":"New Patient Forms"},"content":{"rendered":"<p><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-1 nonhundred-percent-fullwidth non-hundred-percent-height-scrolling fullwidth-padding-box\" 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:2%;--awb-padding-bottom:2%;--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_2 1_2 fusion-one-half fusion-column-first\" style=\"--awb-bg-size:cover;width:50%;width:calc(50% - ( ( 4% ) * 0.5 ) );margin-right: 4%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-column-wrapper-legacy\"><div class=\"fusion-title title fusion-title-1 fusion-sep-none fusion-title-text fusion-title-size-three\" style=\"--awb-margin-bottom:20px;--awb-margin-top-small:0px;--awb-margin-right-small:0px;--awb-margin-bottom-small:20px;--awb-margin-left-small:0px;\"><h3 class=\"fusion-title-heading title-heading-left fusion-responsive-typography-calculated\" style=\"margin:0;--fontSize:24;--minFontSize:24;line-height:1.5;\">New Patient Forms in English<\/h3><\/div><ul style=\"--awb-size:18px;--awb-iconcolor:#5da0b2;--awb-line-height:30.6px;--awb-icon-width:30.6px;--awb-icon-height:30.6px;--awb-icon-margin:12.6px;--awb-content-margin:43.2px;\" 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-file-pdf fas\" aria-hidden=\"true\"><\/i><\/span><div class=\"fusion-li-item-content\">\n<p><a href=\"\/wp-content\/uploads\/sites\/187\/2021\/08\/InitialHistoryQuestionnaire.pdf\" target=\"_blank\" rel=\"noopener\">Initial History Questionnaire<\/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=\"\/wp-content\/uploads\/sites\/187\/2021\/08\/VIP_New_Patient_Form.pdf\" target=\"_blank\" rel=\"noopener\">New Patient Form<\/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=\"\/wp-content\/uploads\/sites\/187\/2021\/08\/VIP_MEDICAL_RECORDS_RELEASE_ENGLISH.pdf\" target=\"_blank\" rel=\"noopener\">Medical Records Release English<\/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=\"\/wp-content\/uploads\/sites\/187\/2021\/08\/NPP_ENGLISH.pdf\" target=\"_blank\" rel=\"noopener\">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-file-pdf fas\" aria-hidden=\"true\"><\/i><\/span><div class=\"fusion-li-item-content\">\n<p><a href=\"\/wp-content\/uploads\/sites\/187\/2021\/08\/NOTICE_OF_NONDISCRIMINATION.pdf\" target=\"_blank\" rel=\"noopener\">Notice of Nondiscrimination<\/a><\/p>\n<\/div><\/li><\/ul><div class=\"fusion-clearfix\"><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-1 fusion_builder_column_1_2 1_2 fusion-one-half fusion-column-last\" style=\"--awb-bg-size:cover;width:50%;width:calc(50% - ( ( 4% ) * 0.5 ) );\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-column-wrapper-legacy\"><div class=\"fusion-title title fusion-title-2 fusion-sep-none fusion-title-text fusion-title-size-three\" style=\"--awb-margin-bottom:20px;--awb-margin-top-small:0px;--awb-margin-right-small:0px;--awb-margin-bottom-small:20px;--awb-margin-left-small:0px;\"><h3 class=\"fusion-title-heading title-heading-left fusion-responsive-typography-calculated\" style=\"margin:0;--fontSize:24;--minFontSize:24;line-height:1.5;\">Formularios en espa\u00f1ol para pacientes nuevos<\/h3><\/div><ul style=\"--awb-size:18px;--awb-iconcolor:#5da0b2;--awb-line-height:30.6px;--awb-icon-width:30.6px;--awb-icon-height:30.6px;--awb-icon-margin:12.6px;--awb-content-margin:43.2px;\" class=\"fusion-checklist fusion-checklist-2 fusion-checklist-default 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\/187\/2021\/08\/VIP_MEDICAL_RECORDS_RELEASE_SPANISH.pdf\" target=\"_blank\" rel=\"noopener\">Medical Records Release Spanish<\/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=\"\/wp-content\/uploads\/sites\/187\/2021\/08\/NPP_SPANISH.pdf\" target=\"_blank\" rel=\"noopener\">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-file-pdf fas\" aria-hidden=\"true\"><\/i><\/span><div class=\"fusion-li-item-content\">\n<p><a href=\"\/wp-content\/uploads\/sites\/187\/2021\/08\/NOTICE_OF_NONDISCRIMINATION.pdf\" target=\"_blank\" rel=\"noopener\">Notice of Nondiscrimination<\/a><\/p>\n<\/div><\/li><\/ul><div class=\"fusion-clearfix\"><\/div><\/div><\/div><\/div><\/div><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-2 fusion-flex-container has-pattern-background has-mask-background fusion-parallax-none nonhundred-percent-fullwidth non-hundred-percent-height-scrolling fullwidth-padding-box\" style=\"--awb-border-sizes-top:0px;--awb-border-sizes-bottom:0px;--awb-border-sizes-left:0px;--awb-border-sizes-right:0px;--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:#697382;--awb-background-image:linear-gradient(180deg, rgba(93,160,178,0.6) 0%,rgba(0,0,0,0.08) 100%),url(https:\/\/www.toplinemd.com\/vip-pediatrics\/wp-content\/uploads\/sites\/187\/2021\/08\/Request-an-appointment-1920x500-1.jpg);;--awb-background-size:cover;--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-flex-start 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-2 fusion_builder_column_2_3 2_3 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:66.6666666667%;--awb-margin-top-large:0px;--awb-spacing-right-large:2.88%;--awb-margin-bottom-large:0px;--awb-spacing-left-large:2.88%;--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%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-text fusion-text-1\"><h2 style=\"text-align: center; color: #fff;\">Request An Appointment<\/h2>\n<\/div><div class=\"fusion-separator\" style=\"align-self: center;margin-left: auto;margin-right: auto;margin-top:0px;margin-bottom:30px;width:100%;max-width:280px;\"><div class=\"fusion-separator-border sep-single sep-solid\" style=\"--awb-height:20px;--awb-amount:20px;--awb-sep-color:#d1d1d1;border-color:#d1d1d1;border-top-width:2px;\"><\/div><\/div><div class=\"fusion-text fusion-text-2 fusion-text-no-margin\" style=\"--awb-margin-bottom:20px;\"><p style=\"text-align: center; color: #fcfcfc;\">Have a question about our practice or want to schedule an appointment? Reach out and speak with a member of our team.<\/p>\n<\/div><div style=\"text-align:center;\"><a class=\"fusion-button button-flat fusion-button-default-size button-default fusion-button-default button-1 fusion-button-default-span fusion-button-default-type\" style=\"--button_text_transform:uppercase;\" target=\"_self\" href=\"\/vip-pediatrics\/contact\/\"><span class=\"fusion-button-text awb-button__text awb-button__text--default\">REQUEST AN APPOINTMENT<\/span><\/a><\/div><\/div><\/div><\/div><\/div>\n<div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-3 hundred-percent-fullwidth non-hundred-percent-height-scrolling fusion-equal-height-columns 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:10px;--awb-padding-bottom:0px;--awb-padding-left:60px;--awb-background-color:#f0f3f6;--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-3 fusion_builder_column_2_3 2_3 fusion-two-third fusion-column-first\" style=\"--awb-padding-top:40px;--awb-bg-size:cover;width:66.6666666667%;width:calc(66.6666666667% - ( ( 0 ) * 0.666666666667 ) );margin-right: 0px;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-column-wrapper-legacy\"><div class=\"fusion-image-element in-legacy-container\" style=\"--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=\"\/vip-pediatrics\/\" target=\"_self\" aria-label=\"VIP-Pediatrics\"><img decoding=\"async\" width=\"270\" height=\"100\" src=\"https:\/\/www.toplinemd.com\/vip-pediatrics\/wp-content\/uploads\/sites\/187\/2021\/08\/VIP-Pediatrics.png\" alt class=\"img-responsive wp-image-1109\" srcset=\"https:\/\/www.toplinemd.com\/vip-pediatrics\/wp-content\/uploads\/sites\/187\/2021\/08\/VIP-Pediatrics-200x74.png 200w, https:\/\/www.toplinemd.com\/vip-pediatrics\/wp-content\/uploads\/sites\/187\/2021\/08\/VIP-Pediatrics.png 270w\" sizes=\"(max-width: 800px) 100vw, 270px\" \/><\/a><\/span><\/div><div class=\"fusion-clearfix\"><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-4 fusion_builder_column_1_3 1_3 fusion-one-third fusion-column-last\" style=\"--awb-padding-top:40px;--awb-bg-size:cover;width:33.3333333333%;width:calc(33.3333333333% - ( ( 0 ) * 0.333333333333 ) );\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-column-wrapper-legacy\"><div class=\"fusion-image-element in-legacy-container\" style=\"--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 MD-RegisterR_Stacked_Logo_rgb_color\" rel=\"noopener noreferrer\"><img decoding=\"async\" width=\"1576\" height=\"376\" src=\"https:\/\/www.toplinemd.com\/vip-pediatrics\/wp-content\/uploads\/sites\/187\/2026\/03\/TopLine-MD-RegisterR_Stacked_Logo_rgb_color.png\" alt class=\"img-responsive wp-image-1168\" srcset=\"https:\/\/www.toplinemd.com\/vip-pediatrics\/wp-content\/uploads\/sites\/187\/2026\/03\/TopLine-MD-RegisterR_Stacked_Logo_rgb_color-200x48.png 200w, https:\/\/www.toplinemd.com\/vip-pediatrics\/wp-content\/uploads\/sites\/187\/2026\/03\/TopLine-MD-RegisterR_Stacked_Logo_rgb_color-400x95.png 400w, https:\/\/www.toplinemd.com\/vip-pediatrics\/wp-content\/uploads\/sites\/187\/2026\/03\/TopLine-MD-RegisterR_Stacked_Logo_rgb_color-600x143.png 600w, https:\/\/www.toplinemd.com\/vip-pediatrics\/wp-content\/uploads\/sites\/187\/2026\/03\/TopLine-MD-RegisterR_Stacked_Logo_rgb_color-800x191.png 800w, https:\/\/www.toplinemd.com\/vip-pediatrics\/wp-content\/uploads\/sites\/187\/2026\/03\/TopLine-MD-RegisterR_Stacked_Logo_rgb_color-1200x286.png 1200w, https:\/\/www.toplinemd.com\/vip-pediatrics\/wp-content\/uploads\/sites\/187\/2026\/03\/TopLine-MD-RegisterR_Stacked_Logo_rgb_color.png 1576w\" sizes=\"(max-width: 800px) 100vw, 400px\" \/><\/a><\/span><\/div><div class=\"fusion-clearfix\"><\/div><\/div><\/div><\/div><\/div>\n<\/p>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":13,"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-1078","page","type-page","status-publish","hentry"],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/www.toplinemd.com\/vip-pediatrics\/wp-json\/wp\/v2\/pages\/1078","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.toplinemd.com\/vip-pediatrics\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.toplinemd.com\/vip-pediatrics\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.toplinemd.com\/vip-pediatrics\/wp-json\/wp\/v2\/users\/13"}],"replies":[{"embeddable":true,"href":"https:\/\/www.toplinemd.com\/vip-pediatrics\/wp-json\/wp\/v2\/comments?post=1078"}],"version-history":[{"count":0,"href":"https:\/\/www.toplinemd.com\/vip-pediatrics\/wp-json\/wp\/v2\/pages\/1078\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.toplinemd.com\/vip-pediatrics\/wp-json\/wp\/v2\/media?parent=1078"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}