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PHONE:

410-697-5357

FAX:

410-457-9626

E-MAIL:
info@kinderhealthmd.com

Forms

School, Camp, Sports, Daycare, and Travel Forms

 

When requesting medical forms, please keep the following in mind:

  • Allow 5 business days for form preparation.
  • Parents must complete the parent section of the form before submitting.
  • In compliance with HIPAA, completed forms will be returned to you via mail, fax, or can be picked up in person. We are unable to send completed forms via email.
  • There is no charge for completing forms, but to help cover administrative costs, we provide each patient with one completed school form per year. If you need the form for multiple purposes (e.g., camp, daycare, etc.), please make copies.

New Patient Forms

 

To complete the new patient intake form online:

  • Medical Release Form – Send this form to your current primary care provider to request your child’s medical records to be transferred to KinderHealth.

Medical Release from KinderHealth

 

If you need to request your child’s medical records from KinderHealth, please complete the form below and return it to us:

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