Patient Resources
Download and complete forms before your visit, and review our office policies to ensure the best experience for you and your child.
Office Resources
Please review our office policies to ensure the best experience for you and your child.
A $25.00 administrative charge will be applied to your account for missed appointments or appointments canceled with less than 24 hours notice.
Out of respect for our patients, if you have more than 3 no-show appointments you may receive a letter of discharge from the practice.
Please end all phone conversations when any provider from the Healthy Kids Care Pediatrics Team is addressing your child's care. We plan on giving you our undivided attention during every encounter with your child. We ask that you extend the same courtesy to each member of our team.
There will be a $25.00 charge for multiple page (5 or more pages) documents (such as school forms, FMLA forms) that need to be completed. Please allow 7 to 10 business days for completion.
FMLA forms have an additional fee of $75.00 and will be completed for patients with ongoing/chronic medical conditions who have a well-established history with our clinic.
Your appointment with the medical assistant is an integral part of your child's visit. This session allows our medical staff to complete all necessary vitals and data collection. If you are not able to make your appointment with the MA, we will need to reschedule your visit with the doctor.
Questions about our policies? Call us at (702) 444-7685
Downloadable
Download and complete these forms before your visit to save time at check-in.
Secure & HIPAA Compliant
Save 15+ Minutes at Check-in
PDF Format
Fee Policy
Demographics Information
Medical Release
Patient Authorization
Patient Demographics
Patient Consent And Disclosure
Release/Hold Harmless (Ear Piercing Consent)
Circumcision Packet
Fee Policy
Newborn Screening Consent (EN/SP)
Sports Physical Information and Consent
Verification Form
Three simple steps to prepare for your visit
Click the form you need and save the PDF to your device.
Fill out the form digitally or print and complete by hand.
Bring the completed form to your appointment or email it to us.
