Patient Forms

Save time when you come into the office by completing your patient forms online. All forms can be signed electronically from your computer or phone.

Refills, Referrals, and Other Paperwork

Please send all refill, referral and other paperwork requests through your patient portal account.

Current Patient Forms

Consent for Non-Parent to Bring Minor Child to Appointment

Authorize another adult to bring your child to their appointment at Peak.

New Patient Forms

All patients must complete this form to be registered at Peak. Please note, that even patients who previously were with Dr. Hansen at Sturdy Pediatrics must complete this form.

Medical Records Release

In order to receive your past medical records from your previous provider, you must complete this form for each child registered at Peak Pediatric Care. We will send your signed copy to the provider’s office and request the records be sent directly to us.

Required Office Policy Forms

Please review and sign our financial, privacy, and vaccine policies. It is important that you take a moment to read through each policy so that you will have a full understanding of the office policies. These policies must be signed by all patients. Save time at your next appointment by signing the forms now.

Health Insurance

Please complete our health insurance form so that we can prepare your account for your first appointment. Completing this form now will allow us to confirm your insurance prior to arriving for your appointment. We will still need to scan your card when you arrive for your appointment, so please be sure to bring it with you.

Release Records From Peak / Transferring Out

Release Your Records from Peak

Whether you are transferring out of Peak Pediatric Care to a new office, or you need your records sent to a specialist, we will need you to complete a medical record release form.

Patient Forms

Save time when you come into the office by completing your patient forms online. All forms can be signed electronically from your computer or phone.

Refills, Referrals, and Other Paperwork

Current Patient Forms

New Patient Forms

Release Records From Peak / Transferring Out

Your trusted partner on the journey to raise healthy, confident kids.

Medical Release Form

Health Insurance Form

Sign our Financial Policy

Sign up to be notified about our April Peak New Patient Session

Become a Peak Patient!

Patient Forms

Save time when you come into the office by completing your patient forms online. All forms can be signed electronically from your computer or phone.

Refills, Referrals, and Other Paperwork

Current Patient Forms

New Patient Forms

Release Records From Peak / Transferring Out

Your trusted partner on the journey to raise healthy, confident kids.

Medical Release Form​

Health Insurance Form​

Sign our Financial Policy​

Sign up to be notified about our April Peak New Patient Session

Become a Peak Patient!

Medical Release Form

Health Insurance Form

Sign our Financial Policy