Patient Forms
These are the forms our practice uses. They come from Privia Medical Group. Check-in at our office is electronic - you will sign these on a screen, not on paper. The copies here are for you to read ahead of time or keep for your records.
No printing needed - check-in is electronic at both offices. Read these ahead if you like.
Sending us records or forms
Have shot records or old records we asked for? Email them to forms [at] drbou.com. Email is not a secure channel, so send only what we asked for. For medical questions, use the patient portal or call the office.
Notice of Privacy Practices
Explains how your child's health information may be used and shared, and how you can see or get a copy of it.
Authorization for Release of Medical Information
Lets you allow us to share your child's health records with a person, doctor, or company you choose.
Authorization and Consent for Treatment
Gives your consent for treatment, for calls, emails, and texts from us, and confirms you accept the costs of care.
Preferred Contacts
Tells us who else may hear about your child's care, like a spouse or grandparent. Helpful but not required.
Financial Policy
Explains that you are responsible for the cost of care, even if your insurance does not pay.
Language Services
Free language help if English is not your first language. This notice lists all available languages.
Patient-Centered Medical Home (PCMH) FAQ
Dr. Bou Pediatrics has been awarded recognition by the National Committee for Quality Assurance Patient-Centered Medical Home Program. This short guide explains what that means for your family.