Bright Star Pediatric & Adolescent Center

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New Patient Packet

Patient Forms

What to bring to your first visit?

Please click on the new patient packet below.  Type in as much information as you can.  Then print and write the information in areas that you was unable to type in.    Please bring the packet in with you when you come in for your visit.   Please bring all the other information listed below.   

NEW PATIENT PACKET

Advance Beneficiary Notice (ABN)

New Patient Packet

  • New Patient Registration

  • Financial Policy

  • Patient Authorization

  • Advance Beneficiary Notice (ABN) Please print from above link.

  • Privacy Policy

  • Patient Family History

  • Patient Medical History

  • Medical Records Release Authorization

  • Authorization to Release Medical Records




We work hard to ensure that your child receives prompt medical care. To help expedite the first visit, you will need:

  • If possible complete all required paperwork from our website days before.  If you are unable to print the forms, please show up 15 minutes early for your appointment to complete the paper work.

  • For Well Child or ADHD visits to complete the Comprehensive Development assessment days before your appt.

  • Your child’s medical records, including immunization records and all pertinent reports

  • Insurance information

  • Parient Driver’s license or government issued ID

  • Childs Social Security Card

  • Payment is expected at time of service. We accept cash, check, Visa, Master Card, American Express and Discover Card.



 
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