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New Patient Forms

If your child is a new patient, you will be asked to complete the following form.

• New patient medical history formÌý(±Ê¶Ù¹ó)

Well-child visit forms

At some of your child’s regular check-ups, you will be asked to fill out a questionnaire about your child’s health. You can complete these forms in advance by downloading the appropriate questionnaire, filling it out and bringing the completed form to your child’s appointment. Please note that not all recommended check-ups will have forms.

• Well-child check: 2 week visit
• Well-child check: 1 month visit
• Well-child check: 2 month visit
• Well-child check: 4 month visit
• Well-child check: 6 month visit
• Well-child check: 9 month visit
• Well-child check: 12 month visit
• Well-child check: 15 month visit
• Well-child check: 18 month visit
  • 18 month visit MCHAT
• Well-child check: 2 year visit
  • 2 year visit MCHAT
• Well-child check: 2 1/2 year visit
• Well-child check: 3 year visit
• Well-child check: 4 year visit
• Well-child check: 5 year visit
• Well-child check: 6 year visit
• Well-child check: 7 year visit
• Well-child check: 8 year visit
• Well-child check: 9-11 year visit
• Well-child check: 12-17 year visit
• Well-child check: 18+ year visit

Administrative forms

• Authorization to consent to medical treatment of a minor
• Authorization for release of health information in English
• Authorization for release of health information in Spanish

From US Highway 101 South
Take the Willow Road exit. Turn right onto Willow Road. Turn left onto Okeefe Street. Turn right onto Menalto Avenue. Turn right onto Gilbert Avenue. 103 Gilbert Avenue will be on the left.

From US Highway 101 North
Take the University Avenue exit toward East Palo Alto/Palo Alto. Keep left to take the ramp toward Palo Alto. Merge onto University Avenue. Turn right onto Woodland Avenue. Turn right onto Menalto Avenue. Turn left onto Gilbert Avenue. 103 Gilbert Avenue will be on the left.

From Highway 280 South
Merge onto CA-92 East toward Hayward/San Mateo. Merge onto US-101 South toward San Jose. Take the Willow Road exit, Turn right onto Willow Road. Turn left onto Okeefe Street. Turn right onto Menalto Avenue. Turn right onto Gilbert Avenue. 103 Gilbert Avenue will be on the left.

From Highway 280 North
Merge onto CA-85 North toward Mountain View. Merge onto US-101 North toward San Francisco. Take the University Avenue exit toward East Palo Alto/Palo Alto. Keep left to take the ramp toward Palo Alto. Merge onto University Avenue. Turn right onto Woodland Avenue. Turn right onto Menalto Avenue. Turn left onto Gilbert Avenue. 103 Gilbert Avenue will be on the left.