The staff at Summit Pediatrics welcomes you to our practice!
We are anxious to meet you and your family! To understand what to expect for your child's first visit to our practice, please read through this page.
We want to be your child's "home" for all of their health care needs. At Summit Pediatrics, we have begun the process of developing and strengthening our Model of Care to become your childs Patient Centered Medical Home. Our Model of Care includes a team of providers who are wholly accountable for your child's health, including prevention and wellness, acute care, and chronic care.
What to bring to your first visit?
We work hard to ensure that your child receives prompt medical care in a comfortable, child-friendly office setting. To help expedite the first appointment, we ask that you please bring your child's insurance card, your driver's license, an up-to-date immunization record, and any past medical records. Be prepared to complete your family medical history, your child's medical history, and insurance information during your visit.
New/Update Patient Forms
To obtain a copy of our Privacy Practices click on the link below
In order to provide you with the best health care possible, it is important that our office receive a full copy of your child's health records, including immunization records, and that you complete our release prior to your first visit. Please give the form to your child's previous heathcare practice, and have them forward a copy of your child's records via mail or fax.
If you would like a copy of your child's medical records, please fill out form below and mail or fax request to our office. Be sure to include exact location you want records mailed or faxed. Please allow 30 days for medical records to be processed.
In some medical records a fee may be applied and must be paid prior to medical records being released, someone will contact you in this If you have trouble obtaining these please email our Clinic Manager. Karie Payne
In order to view or print these forms you will need Adobe Acrobat Reader installed. Click here to download it.
Sports/Camp/Daycare Physical Forms
- MSHSAA Sports Physical Form
- Child Medical Examination Report (Infant/Toddler/Preschool Form)
- Boy Scout Camp Physical Form
- Summit Pediatrics Abdominal Pain Log
- Summit Pediatrics Albuterol Trial Log
- Summit Pediatrics Headache Log
Summit Pediatrics Policies
Summit Pediatrics Late Policy