Patient Forms

Parent Responsibilities

Please print and complete the following form and fax it to our office at 833-971-1923 before your first appointment with Dr. Patti.

• Parent Responsibilities Form

Medical Records Release

Please use the form below to authorize release of your child's medical records to Patti's Place: Vital Pediatrics for Complex Kids.

• Medical Records Release Form

Patient Privacy

Please print the following documents for your records.

• HIPAA Notice of Privacy Practices

Telemedicine Satisfaction Survey

Please take a few moments to answer this brief survey regarding your recent telemedicine experience with your Patti's Place telemedicine visit.

• Print the Survey