We provide a range of useful information including new patient forms, general forms, policies, and more. To download any of these documents, simply click on the corresponding link below.

New Patient Forms

  1. Acknowledgement of Receipt of Notice of Privacy Practices
  2. Family Registration Form or Click here to download PDF Version
  3. Consent to Treat
  4. Financial Policy

General Forms

  1. No Show Policy
  2. Patient Health Questionnaire
  3. M-Chat
  4. Over 18 HIPPA Release Form

Transfer Forms

  1. If you are joining Guardian Pediatrics, and you would like to request records from your previous practice: Download Release Form
  2. If you are leaving Guardian Pediatrics, and you would like for us to send your child’s records to your new practice: Download Release Form


Daycare Form

Click the following link to download the state-issued daycare form that most daycares use. Download Daycare Form


Click the following link to download the pre-participation physical evaluation form (PPE) – download form.


NICHQ, National Institute for Children’s Health Quality, offers an assessment scale used in diagnosing ADHD. Click the following link to download the form – NICHQ Vanderbilt Assessment Scales

Vaccine Information

This download includes everything you need to know about your child’s first vaccines. To download the vaccine information, please click the following link. Download Your Child’s First Vaccine Information


At Guardian Pediatrics, we put your child’s health first.
Our team of doctors sees children whose ages range from newborns through young adulthood.

Call 317-848-3040 for appointments and information.