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Before you have an appointment with Ms. Peggi please print and fill out the following forms:

 

  1. Patient Registration Form

  2. Patient History Form

  3. HIPPA Consent Notice Form

  4. Cancellation of Appointment Form – Form will be live on website by, 8.2.17.

If Miss Peggi shows up at your house during the designated appointment window and you do not show up to have your child/ren seen. You will be charged a $50 cancellation fee. 

  1. RELEASE OF MEDICAL INFORMATION FORM

First copy of medical records free. Fee will be charged for any additional requests. 

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