Pediatric Associates of Lancaster Inc: Forms

740-687-6386
1-800-222-1222

In this section...

Forms

M-CHAT (Modified Checklist for Autism in Toddlers)

New Patient Demographics

New Patient Questionnaire

Office and Financial Policy

Ohio School Athletic Association Preparticipation Physical Evaluation

Patient Consent for Use and Disclosure of Protected Health Information

Prenatal Visit Questionnaire

Pediatric Associates of Lancaster, Inc.

1550 Sheridan Drive, Suite 102

Lancaster, OH 43130

Phone: 740-687-6386

Fax: 740-687-1388

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