Medical Records Release to Us

Medical Records Release From Us

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Patient Forms

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Below are several forms that are used in our practice. Please choose the form you are looking for and print for your convenience. The questionnaires must be filled out and brought with you to your child's well child appointment, or filled out and emailed to our office. You must download the file first and save to your computer, prior to filling out the form. If you fill out the form before downloading the file, your changes will NOT be saved. If you wish to email to us, please send to billing@bgimp.com.

Consent to Treat-Please fill out this form if anyone other than a parent or guardian is to accompany a child under the age of 18 to the physician's office.

Well Child Exam Information
3-5 Days Well Visit Handout
3-5 Days Well Visit Questionnaire

1 Month Well Visit Handout
1 Month Well Visit Questionnaire

2 Month Well Visit Handout
2 Month Well Visit Questionnaire

4 Month Well Visit Handout
4 Month Well Visit Questionnaire

6 Month Well Visit Handout
6 Month Well Visit Questionnaire

9 Month Well Visit Handout
9 Month Well Visit Questionnaire

12 Month Well Visit Handout
12 Month Well Visit Questionnaire

​15 Month Well Visit Handout
15 Month Well Visit Questionnaire

18 Month Well Visit Handout
18 Month Well Visit Questionnaire

2 Year Well Visit Handout
2 Year Well Visit Questionnaire

3 Year Well Visit Handout
3 Year Well Visit Questionnaire

4 Year Well Visit Handout
4 Year Well Visit Questionnaire

5 Year Well Visit Handout
5 Year Well Visit Questionnaire

6 Year Well Visit Handout
6 Year Well Visit Questionnaire

7 Year Well Visit Parent Handout
7 Year Well Visit Patient Handout
7 Year Well Visit Questionnaire

8 Year Well Visit Parent Handout
8 Year Well Visit Patient Handout
8 Year Well Visit Questionnaire

9 Year Well Visit Parent Handout
9 Year Well Visit Patient Handout
9 Year Well Visit Questionnaire

10 Year Well Visit Parent Handout
10 Year Well Visit Patient Handout
10 Year Well Visit Questionnaire

11-14 Year Well Visit Parent Handout
11-14 Year Well Visit Patient Handout
11-14 Year Well Visit Parent Questionnaire
11-14 Year Well Visit Patient Questionnaire

15-17 Year Well Visit Parent Handout
15-17 Year Well Visit Patient Handout
15-17 Year Well Visit Parent Questionnaire
15-17 Year Well Visit Patient Questionnaire

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