Forms & Policies
TLC Pediatrics of Amarillo, PA is an independent, self-owned and operated pediatric group. On this page, you’ll find information about our general office policies as well as links to some of the forms that you can print out and fill out before your appointment to save time.
Forms
To expedite the registration process and for your convenience several forms are made available in PDF format for printing and completion. You can download (using the free Adobe Reader software) and print out. Filling out these forms prior to your office visit can save you time. Please either print the blank forms and fill them out by hand, or simply fill out the forms electronically while online and then print your completed forms (clicking on the editable areas of the form will allow you to fill in your information).
Please send the completed forms to registration@drmaaytah.com
- Patient Information form
- Medical History & Insurance Information Form
- Responsible Party Statement
- Authorization and Consent Form
- HIPPA Acnowledgement
- Financial Policy Form
- Credit Card Charge Authorization
- Medical Record Release to TLC Pediatrics
- Medical Record Release from TLC Pediatrics
If you are unable to open the for please click here to get Adobe Reader: