New Patient Forms
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We have compiled all of the forms that we require for our new patients. We ask that all new families print and fill them out and bring them with you to your child's first appointment. It contains all of Milestones Pediatrics Privacy and Financial policies, as well as our insurance and medicals records consents.
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Click icon below to download.
Annual Update​
We ask that all patients update their demographic forms once a year so that we can be sure that we know the best way to contact you. Please notify us as soon as possible when any of your contact information, for example address or phone number, changes. We also need to have an updated non-parent emergency contact for your child.
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Medical Records Release
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If your child has been seen by any other medical healthcare provider please fill out this form and bring it with you to your child's next appointment or fax it to our office at (352) 559-8877. This allows us to get medical information from the other healthcare providers, including any tests that were done, medications given and diagnoses.
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Click form below to download.
Florida High School Athletic Association Physical Evaluation
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This form is required for all Florida high school students who participate in sports through their high school. Please have the first page filled out before your child's appointments, we will fill out the rest. This form is valid for 1 year so it will need to be completed annually.
Click form below to download.
Ages and Stages Questionnaires
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Please print and complete the age appropriate form. Leave the last page of the document blank and hand it to our staff during your visit. All scoring will be performed by our staff members.
Click form below to download.
Attention Deficit Disorder (ADD) and Attention Deficit and Hyperactivity Disorder (ADHD)
Click form below to download.