Forms and Appointments

We provide complete preventive and sickness medical primary care for the pediatrics population up to early adulthood at 21 years of age.

In case of a medical emergency call 911 immediately.
In case of a poisoning call the poison center hotline at 1-800-222-1222 immediately.

Co-payments are required by insurance companies to be collected at the time services are rendered. We accept cash and credit cards, but unfortunately do not accept checks.

We accept Full Medicaid, most Medicaid HMOs, and all major insurances.

Please read our policies.

Please download, complete, and print the Registration forms listed below.

0-1 years old, English Forms


0-1 years old, Spanish Forms


1-6 years old, English Forms


1-6 years old, Spanish Forms


7-21 years old, English Forms


7-21 years old, Spanish Forms


Please bring the above registration froms as well as the following documents with you to your appointments:

1- Proof of medical insurance

2- Valid Photo ID

3- Complete immunization record

4- Previous medical history documents, if available