Below are some of our most commonly used forms. To expedite your first visit with us just print and fill out the forms below before coming into our office.
- New Patient Forms
- Request Records From Your Previous Provider
- Request Records From Seaview Pediatrics
- School, Camp, Medication Forms
Please print and complete all the forms below. Bring them along with your insurance card and immunization records to your first appointment. It will help to expedite the check in process.
- Sea View Pediatrics Immunization Policy
- Sea View Pediatrics Patient Information Form
- Sea View Pediatrics Confidential Health Questionnaire
- Sea View Pediatrics Office Policy & Eligibility Waiver
- Sea View Pediatrics Authorization to Consent to Treatment of a Minor
- Receipt of Privacy Practices
We cherish our relationships with our patients and their families. It is truly what makes our job fulfilling.
In the midst of the recent measles outbreak, it has raised many questions among our physicians about what is our responsibility to the safety of our patients, parents, physicians and staff. We have had to make some difficult decisions which we feel are for the greater good of our community.
Although we have always been supportive of the AAP immunization guidelines, in the past we have allowed some variation and modification of that schedule. Some families have also chosen not to vaccinate. We have come to recognize that both decisions place the health of your child and others at risk.
We understand that as a parent, you may have a lot of questions and fears regarding health decisions for your children including vaccinations. We are dedicated to discussing these issues with you. If after careful consideration, you choose not to vaccinate your child, we ask that you seek an alternative provider for your family. Sea View will no longer provide care for children who are not vaccinated.
We feel that it is in the best interest of your child and our community that you vaccinate and protect your child according to the recommended AAP immunization schedule. (Please see the immunization section below). We will also be actively updating our current patients who have fallen behind on their scheduled immunizations.
In the event of particular circumstances where a modified schedule is essential, a Sea View modified schedule that still adequately protects your child with less risk will be adopted. You may discuss the details with your physician. Other modified schedules which significantly delay infant immunizations will no longer be accepted at Sea View.
If you would like Sea View Pediatrics to request records for you from your previous pediatrician, please print and complete this form and bring it along with your new patient paperwork and we will be happy to fax it to your previous provider.
If you would like to request a copy of your medical records from Sea View Pediatrics, please print and complete this form, and drop it off at any Sea View location. Please allow 5 to 7 business days for us to copy your child’s records. There is a $20.00 records fee which can be paid when you drop off the request form or if you wish, when you pick up your records. You may also fax your request to (949) 951-2715. Once received someone will contact you for payment over the phone and to confirm where we are to send the records.
Please bring your forms to us as soon as you receive them to avoid the rush. Be sure to fill in your CHILD’S NAME and DATE of BIRTH along with all the portions designated to be filled out by parent PRIOR to submitting your form to us. Completing these areas on the forms helps us ensure utmost accuracy and completeness of forms.
If you are bringing a form with you to your appointment, in most cases, we will be able to complete your form before you leave that day. There are times when our office is extremely busy and you may be asked to leave the form with us for a few days.
If you are dropping off, faxing or emailing a form to us, please allow 3 to 5 business days to complete. We will call you when your form is ready to be picked up. Sea View does charge a $10.00 form fee.