Your First Visit to Jeffers, Mann and Artman Pediatrics

Thank you for visiting Jeffers, Mann and Artman Pediatrics. In order to make your visit as easy as possible please read the directions below and make sure that you have all of the listed information with you when you come to the office.

Please fill out the following forms and bring them with you on your first visit. Type directly on each form
when it comes up on your screen, then print it out. Form downloads may take 25-30 seconds.

Patient Profile Form Medical History Form HIPAA-Notice of Privacy Practices HIPAA-Privacy Information HIPAA-Written Acknowledgement Form

Bring a Copy Of Your Insurance Information

Parent/Guardian Must Bring Their Driver's License

If Your Child Has Received A Social Security Card, Please Bring It With You