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Forms & Policies

New Patient Registration

  • Patient Information

  • Newborn (0-6 months) Medical Information

  • Pediatric (6 months+) Medical Information

You should download, print and complete the forms that are needed for your child. If you have more than one child who will be coming to Shoreline Pediatrics, you will need to complete a set of forms for each child. Sorry about that.  Please note, these forms are to be filled out by the parent (biological, adoptive, or  foster) or legal guardian.  A parent (biological, adoptive, or foster) or legal guardian must accompany the child/children for the initial visit.  The parent or legal guardian completing the paper work can designate other individuals (step-parent, grandparent, etc.) consent to bring the child in for future visits by completing the "Consent for Care" form. 

For All New patients


  • A parent (biological, adoptive, or foster) or legal guardian must be with the child the first checkup.

  • Picture IDs of the parent (biological, adoptive or foster) or legal guardian are required along with current insurance information.

  • If there are any child custody or guardianship issues, we will also need to see the legal documents and make copies.


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