Patient Forms

To expedite your first visit with us just print and fill out the forms below before coming into our office.

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

Notice of Privacy Practices – For your review

Request Records from Your Previous Provider

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.

Request Records from Sea View Pediatrics

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.

School, Camp, Medication Forms

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.