Thank you for choosing Healthy Horizons Pediatrics as your child's medical home, where we always provide a comfortable, caring environment so our patients and their families can feel at ease. We've included helpful items on this page to ensure you and your child's first trip to our office is productive, stress-free and enjoyable.
The Initial Visit
Our compassionate pediatricians do whatever it takes to make every visit to our office a pleasant and relaxed experience. With all of the important information about our practice available on our website, you can feel confident that you and your child are well-prepared for your first appointment. We also invite you to review our staff page in order to get to know our doctors and staff. We look forward to meeting you.
New Patient Forms
To expedite your first appointment, please arrive a few minutes early to complete registration forms so that we have all the necessary information to treat your child. You may also download and print the forms from this website, fill them out ahead of time, and bring them with you to the first appointment.
- Patient Registration form
- New Patient Welcome Letter
- Release of Medical Information Form-Kokomo
- Release of Medical Information Form-Lafayette
- Notice of Privacy Practices
- Patients' Rights and Responsibilities
- Office Policies
- Financial Policy
- Sports Physical Form
- Daycare Physical Form
- Consent to Participate in Telemedicine Consultation
Please log on to the patient portal to print out the following forms:
- Ages and Stages Questionnaire (ASQ - 3) - 9-month-old child
- Ages and Stages Questionnaire (ASQ - 3) - 18-month-old child
- Ages and Stages Questionnaire (ASQ - 3) - a 30-month-old child
- Modified Checklist for Autism in Toddlers – M-CHAT
- Patient Health Questionnaire –9 modified for Adolescents (PHQ-A)
- Vanderbilt Parent and Teacher Forms for ADHD Evaluation
- Asthma Control Test (ACT) Form for Children 4 to 11 years old
- Asthma Control Test (ACT) Form for Children 12 years and older
In order to view or print these forms, you will need Adobe Acrobat Reader installed. Click here to download it.