“Love the doctors and nurses here at Southdale Peds. In fact, I have recommended it to all my friends and about five more families are coming here. We moved to Plymouth but I'll keep coming here as long as I can!”
“I have been bringing my kids to Southdale Pediatrics for over 10 years. All of the doctors are top-notch, dedicated and so accessible. I love the ease and availability of scheduling appointments, especially for my "medically challenged" child who many times needs to be seen within hours. I have complete trust in the excellent medical staff at Southdale Peds and highly recommend them!”
Here at Southdale Pediatrics, we know that it can be a time-consuming process to fill out patient forms for you or your child. However, the information you provide is vital to us–we need to have certain background information in order to give your child the best health care possible. We also need certain information for billing purposes, for our medical records department, and to follow governmental guidelines and regulations. That's why we've supplied links below so that you can fill out forms at your convenience.
The Release of Information form gives us the authority to release your medical records. Patients under 18 must have their parent or guardian sign the form. Those 18 and up need to sign the form themselves. Seven to 10 business days are needed to process the form.
The Consent for Disclosure form gives other individuals the ability to participate in discussions and decisions related to medical care when the patient is over 18 years old.
Illness or emergencies can strike at any time and we want to help you be prepared. A Parental Consent for Medical Treatment form is wise to have on hand. Whether you're traveling for business, are away for a weekend, or are merely out for a date night, your child's caregiver is not authorized to give consent for treatment for your child without the necessary documentation. The Parental Consent for Medical Treatment form provides the needed information, giving you peace of mind when you're away from your child. Please make sure that your child's caregiver has a copy for each child and brings it to the clinic when needed.
If your child in grades seven through 12 is going to be participating in school athletics, he or she will need the following form filled out before the sports season begins. Please be sure to answer the questions on page two because the pediatrician will need to review these answers before signing the form.
Thank you for choosing Southdale Pediatrics. The following are forms that we need as we start caring for your family. For your convenience, you may select the links below to print them and fill them out before your first visit.
Southdale Pediatrics looks forward to helping you manage your allergies, asthma, and other related issues. For your convenience, new patients may choose to print and fill out the forms below prior to coming in for an initial visit.
When you need to refill your child's ADHD medication, we have a convenient 24-hour prescription service that you can use. The number is (952) 841-8436. We do, however, need certain information in order to fulfill your request, and that is clearly listed in the following link. We need five business days in order to process the request, and it is only for ADD/ADHD medicine.
Impact testing is a computerized exam given to athletes 12 years of age and older when they are well and uninjured. This baseline test can then be used to compare to future testing which may be administered if the athlete sustains a head injury (concussion). To schedule an assessment call (952)278-6939. Print the consent form below, sign and return at the time of testing. Further information can be found at impacttest.com or by calling our Nurse Advisors at (952)278-7009.