Forms and Registration

You may access the following forms to assist us with your care. Please print and complete the following forms, and bring them to your appointment.

New Patient Forms

Yearly Updates

We require a yearly update to the following forms:

Consent Forms

It is generally our policy that all patients under 18 years of age must be accompanied to all appointments by a parent or legal guardian. Learn more about our policy.

  • Consent to Treat – Use for a one-time case where you will not be able to accompany your child to the office. A signed, faxed "Consent to Treat" form, sent by the parent with a valid phone number where the parent can be reached during the appointment. The parent MUST be available.
  • Power of Attorney – If the parent will not be available (out of the country, etc.) during the appointment, a "Power of Attorney" form must be filled out and brought by the caretaker to any appointments while the parents are unavailable.
  • 18+ Year Consent Form – If the patient is over the age of 18, they must have a signed consent on file.
  • 18 Year Old Financial Form
  • 16+ Year Consent Form – If the patient is over the age of 16, they must have a signed consent on file to be seen without a parent/guardian present. However, a parent/guardian still needs to be available at any appointments requiring procedures (including vaccines) to sign consent at the time of the visit.

Administrative Forms

Behavior and Development Forms

These Vanderbilt Parent & Teacher Rating Forms for ADD/ADHD may be requested as part of an evaluation for ADD/ADHD. Kindly complete and fax to our office at (480) 860-8498. Please put the attention to your child’s physician.

Sports/School Physical Forms

  • AIA Form - Sports clearance form accepted by most schools and teams. Please fill out the first 3 pages and bring the packet with you to your child's well visit. If your child already had a well visit within the past 12 month, please drop off the completed packet to the front desk or e-mail to carecoordinator@nspeds.com and we will return the signed forms to you within 48-72 hours.

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North Scottsdale Pediatrics

  • Ironwood Office - 9827 N. 95th St. Suite 105, Scottsdale, AZ 85258 Phone: (480) 860-8488 Fax: (480) 860-8498
  • Deer Valley Office - 21807 N. Scottsdale Rd., Scottsdale, AZ 85255 Phone: (480) 860-8488 Fax: (480) 860-8498

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