Patient Forms

Johnson County Pediatrics welcomes new patients. Choosing the right pediatrician for your child is one of the most important decisions you will make. By selecting Johnson County Pediatrics, you can feel confident and comfortable that you have made the right decision.

To understand what to expect for your child's first visit to our practice, please read through this page.

Our Mission

Our practice is working together to build life-long relationships between our staff and our patients by consistently providing our patients with compassion, excellence and value. To fulfill this mission, we are committed to:

  • Improving the lives of the children we serve by providing quality care in a child-centered environment.
  • Listening to our young patients and their families who we are privileged to serve.
  • Guiding our patients along a path of optimal health and wellness.
  • Continually pursuing excellence at all levels through continuing education.

What to bring to your first visit?

We work hard to ensure that your child receives prompt medical care in a comfortable, child-friendly office setting. To help expedite the first appointment, we ask that you please bring your child's immunization records and be prepared to complete paperwork regarding your family medical history, your child's medical history, and insurance information.

Patient Forms

We are also happy to offer you the option to download, print and complete our office forms to reduce wait times during your first appointment.

If you desire a complete copy of your child's chart, a signed release and payment will be required prior to the release of the copied chart. A parent or legal guardian may request the following information: a copy of the immunization record, growth chart and last well check-up for a fee of $5 per child. Any additional copies of the above information or any other copying requests for the patient will be billed at the rate governed by Kansas law (KSA 65-.4971b). These rates change yearly by law and can be quoted to you over the phone. The copy will be ready within 30 days after payment is received and you will be notified by phone. Please contact the office with any further questions regarding this policy.

Vanderbilt Forms for Parents and Teachers

Organization /School Forms

In order to view or print these forms you will need Adobe Acrobat Reader installed. Click here to download it.

What to Expect

On the day of your child's first visit to our office, we recommend arriving a few minutes early. This allows extra time for finishing up any registration forms and ensures you have plenty of time to get acquainted with our staff and office. We look forward to meeting you and joining with you to help your child maintain optimal health.