Registration

Want to save a bunch of time on your first visit? Now you can download, print and fill out our new patient registration forms in the comfort of your own home!

To download any of our forms, see the links below. :)

Of course, you are more than welcome to complete any of the forms in our office too.

New Patient Registration

At Springville Pediatrics, we want to make your first time visit with us as easy and hassle-free as we can. So before your visit, be sure to bring a copy of the parent/guardian’s photo id, a copy of the insurance card the child/ children are on (if they have insurance), and a copy of his or her immunization record.

If the child is adopted, being fostered, or you have custody of the child, be sure to bring a copy of the court papers for him/ her indicating so.

Registration Forms to Download or Print

• Patient Sign Up Sheet
• Patient Registration Form
• Patient Medical History
• Office Policies
• Financial Policy
• Payment Plan Agreement
• Notice of Privacy Practices
• HIPAA Authorization to Release