{"id":106,"date":"2023-04-13T20:04:04","date_gmt":"2023-04-14T03:04:04","guid":{"rendered":"http:\/\/www.ccckids370.com\/blog\/?page_id=106"},"modified":"2026-03-15T15:31:17","modified_gmt":"2026-03-15T22:31:17","slug":"patient-forms","status":"publish","type":"page","link":"https:\/\/www.ccckids370.com\/blog\/patient-forms\/","title":{"rendered":"Patient Forms"},"content":{"rendered":"\t\t
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WELCOME to<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t
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Chehalis Children's Clinic<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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\u201cThe greatest legacy we can leave our children is happy memories.\u2763\ufe0f<\/p>

\u2014 Og Mandino<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t

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\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\tNew Patient Paperwork<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\tAnnual Existing Patient Paperwork<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t18 Yrs & Older Paperwork<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\tMedical Records Release Form<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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Thank you for filling out our paperwork.\u00a0<\/strong><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

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Speak to your Children as if they are the Wisest, Kindest, most Beautiful, and Magical Humans on the Earth, for what they believe is what they become.\u00a0<\/em>-Brook Hampton<\/b><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t

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\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t
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\n\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\tAPPOINTMENTS<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t

* Regular office hours begin at 9:00 a.m. Monday through Friday, except holidays.
* We will begin answering phones at 8:00 a.m. for appointments.
* Saturday and Sunday 10:00 a.m. to 1:00 p.m. for urgent care appointments.
* We ask that you make appointments in advance so that we can provide time for every patient. If you need to cancel your appointment, please make sure to call to cancel as soon as possible. If you do not cancel or keep your appointment two times or more you may be dismissed from the clinic care. Please be aware that a missed\u00a0appointment could have been utilized for someone else.
* To try to prevent the spread of infections, please limit the number of persons brought along for an appointment.
* Please keep us informed of all the changes in your address, phone numbers, insurance or emergency contacts.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t

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\n\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\tPREVENTATIVE MEDICINE<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t

* Well-Baby check-ups immunizations\u00a0can be\u00a0scheduled at 2 weeks, 2 months, 4 months, 6months, 9 months, 12 months,
18 months and 2 years. Thereafter, well-child preventative visits are recommended annually.
* Beginning at 2 months of age, immunizations are evaluated at each well-child
* Please bring your child’s shot records to each well-child appointment so it can be update\u00a0as needed.<\/b><\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t

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* Private pay patients are expected to pay their co-insurance cost at the time of service.\n* If for some reason you are unable to pay at the time of your visit, please speak with our bookkeeper so a suitable\npayment can be worked out for you.\n* Statements will be mailed before the end of each month if you have a personal balance. Our computer automatically\nadds a minimum $2.00 interest charge on all balances over 60 days.<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t
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* Yes. Please call the office prior to your appointment to verify that we contract with your insurance company
* When you have insurance, please provide us with your group and subscriber numbers at each visit.
* Co-pays are required to be paid at the time of service (as part of our contract with your health plan). You will \u00a0receive a statement after we hear from your insurance company.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t

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\n\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\tALLERGY SHOTS<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t

* Allergy shots are available during regular office hours Monday through Friday.
* Keep in mind that patients are required to stay in the clinic for 30 minutes following each injection.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t

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\n\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\tLAB TESTS<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t

* Occasionally, the doctor will need a lab test to verify the best course of treatment for your child.
* In the event that you visit the clinic in order to drop off a specimen or to have a specimen collected, a minimum
\u00a0\u00a0\u00a0office call will be charged.
* You will be notified of any lab results which are not within normal limits.
* Some specimens are sent to an outside lab. You will receive a bill from the lab for work done by them.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t

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\n\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\tAFTER HOURS CARE<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t

* If you feel your child has a medical problem that cannot wait until regular office hours, please call (360) 748-6693 to
\u00a0\u00a0\u00a0speak with our answering service.
* Our providers are on call 24 hours a day.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t

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\n\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\tMEDICAL REFILLS \/ RECHECKS<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t

* Please be aware that any changes in continuing medication requires a follow up appointment.
* Please call ahead to make a medication recheck appointment.
* Also, please provide a 48-hour notice to our clinical staff for any needed medication refills.\u00a0
* Always be prepared for vacation or any travel plans that you have enough medication for the trip! Call ahead!<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t

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* Thank you for choosing Chehalis Children’s Clinic<\/strong> <\/em>for your child’s care!
* Remember to visit our Facebook page!<\/a><\/span><\/p>

We look forward to your visit with us!<\/strong><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

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New Patient \/ First\u00a0 Appointment<\/strong><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t

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WELCOME to Chehalis Children’s Clinic \u201cThe greatest legacy we can leave our children is happy memories.\u2763\ufe0f \u2014 Og Mandino New Patient Paperwork Annual Existing Patient Paperwork 18 Yrs & Older Paperwork Medical Records Release Form Thank you for filling out our paperwork.\u00a0 Speak to your Children as if they are the Wisest, Kindest, most Beautiful, […]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"elementor_header_footer","meta":{"ocean_post_layout":"","ocean_both_sidebars_style":"","ocean_both_sidebars_content_width":0,"ocean_both_sidebars_sidebars_width":0,"ocean_sidebar":"","ocean_second_sidebar":"","ocean_disable_margins":"enable","ocean_add_body_class":"","ocean_shortcode_before_top_bar":"","ocean_shortcode_after_top_bar":"","ocean_shortcode_before_header":"","ocean_shortcode_after_header":"","ocean_has_shortcode":"","ocean_shortcode_after_title":"","ocean_shortcode_before_footer_widgets":"","ocean_shortcode_after_footer_widgets":"","ocean_shortcode_before_footer_bottom":"","ocean_shortcode_after_footer_bottom":"","ocean_display_top_bar":"default","ocean_display_header":"default","ocean_header_style":"","ocean_center_header_left_menu":"","ocean_custom_header_template":"","ocean_custom_logo":0,"ocean_custom_retina_logo":0,"ocean_custom_logo_max_width":0,"ocean_custom_logo_tablet_max_width":0,"ocean_custom_logo_mobile_max_width":0,"ocean_custom_logo_max_height":0,"ocean_custom_logo_tablet_max_height":0,"ocean_custom_logo_mobile_max_height":0,"ocean_header_custom_menu":"","ocean_menu_typo_font_family":"","ocean_menu_typo_font_subset":"","ocean_menu_typo_font_size":0,"ocean_menu_typo_font_size_tablet":0,"ocean_menu_typo_font_size_mobile":0,"ocean_menu_typo_font_size_unit":"px","ocean_menu_typo_font_weight":"","ocean_menu_typo_font_weight_tablet":"","ocean_menu_typo_font_weight_mobile":"","ocean_menu_typo_transform":"","ocean_menu_typo_transform_tablet":"","ocean_menu_typo_transform_mobile":"","ocean_menu_typo_line_height":0,"ocean_menu_typo_line_height_tablet":0,"ocean_menu_typo_line_height_mobile":0,"ocean_menu_typo_line_height_unit":"","ocean_menu_typo_spacing":0,"ocean_menu_typo_spacing_tablet":0,"ocean_menu_typo_spacing_mobile":0,"ocean_menu_typo_spacing_unit":"","ocean_menu_link_color":"","ocean_menu_link_color_hover":"","ocean_menu_link_color_active":"","ocean_menu_link_background":"","ocean_menu_link_hover_background":"","ocean_menu_link_active_background":"","ocean_menu_social_links_bg":"","ocean_menu_social_hover_links_bg":"","ocean_menu_social_links_color":"","ocean_menu_social_hover_links_color":"","ocean_disable_title":"default","ocean_disable_heading":"default","ocean_post_title":"","ocean_post_subheading":"","ocean_post_title_style":"","ocean_post_title_background_color":"","ocean_post_title_background":0,"ocean_post_title_bg_image_position":"","ocean_post_title_bg_image_attachment":"","ocean_post_title_bg_image_repeat":"","ocean_post_title_bg_image_size":"","ocean_post_title_height":0,"ocean_post_title_bg_overlay":0.5,"ocean_post_title_bg_overlay_color":"","ocean_disable_breadcrumbs":"default","ocean_breadcrumbs_color":"","ocean_breadcrumbs_separator_color":"","ocean_breadcrumbs_links_color":"","ocean_breadcrumbs_links_hover_color":"","ocean_display_footer_widgets":"default","ocean_display_footer_bottom":"default","ocean_custom_footer_template":"","footnotes":""},"class_list":["post-106","page","type-page","status-publish","hentry","entry"],"yoast_head":"\nPatient Forms - Chehalis Children's Clinic, PS<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.ccckids370.com\/blog\/patient-forms\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Patient Forms - Chehalis Children's Clinic, PS\" \/>\n<meta property=\"og:description\" content=\"WELCOME to Chehalis Children’s Clinic \u201cThe greatest legacy we can leave our children is happy memories.\u2763\ufe0f \u2014 Og Mandino New Patient Paperwork Annual Existing Patient Paperwork 18 Yrs & Older Paperwork Medical Records Release Form Thank you for filling out our paperwork.\u00a0 Speak to your Children as if they are the Wisest, Kindest, most Beautiful, […]\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.ccckids370.com\/blog\/patient-forms\/\" \/>\n<meta property=\"og:site_name\" content=\"Chehalis Children's Clinic, PS\" \/>\n<meta property=\"article:modified_time\" content=\"2026-03-15T22:31:17+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/www.ccckids370.com\/blog\/wp-content\/uploads\/2023\/04\/Mascot-Cat-1-e1681280863260.jpg\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"4 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/www.ccckids370.com\/blog\/patient-forms\/\",\"url\":\"https:\/\/www.ccckids370.com\/blog\/patient-forms\/\",\"name\":\"Patient Forms - 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