New Patients

In an effort to keep wait times down, we ask that new patients to our practice, arrive 10-15 minutes before your scheduled visit time.

Hartland Pediatrics requires that one biological parent or legal guardian accompany the patient to their first appointment. This cannot be a step-parent, grandparent, sibling, etc. If you are the legal guardian of the patient, we require that you bring legal documentation for that patient.

Please bring the following items to your child’s first appointment:

- Biological Parent or Legal Guardian Photo ID
- Insurance Card(s) - If child is covered by multiple insurance companies, please bring all insurance cards
- Legal documentation - Foster paperwork, custody paperwork, etc.
- Immunization Record - If child has received immunizations outside of the state of Michigan
- New Patient Paperwork : (Printable forms available below)
1. New Patient Intake Form
2. New Patient Intake - Show Policy
3. New Patient Intake - Consent to Treat a Minor Without Parent/Legal Guardian
5. Medical Record Request Form - Records to Hartland Pediatrics

** Failure to bring in the information listed above, may result in your child’s appointment being rescheduled. **

FORMS

Please click on the underlined to open each form to print

  1. New Patient Intake Form

  2. New Patient Intake - No Show Policy

  3. New Patient Intake - Consent to Treat a Minor without Parent/Legal Guardian

  4. Notice of HIPAA Privacy Practice