{"id":2449,"date":"2025-10-25T13:50:16","date_gmt":"2025-10-25T13:50:16","guid":{"rendered":"https:\/\/stage.myliquis.co\/great_destinations\/?page_id=2449"},"modified":"2026-01-21T20:28:39","modified_gmt":"2026-01-21T20:28:39","slug":"patient-forms","status":"publish","type":"page","link":"https:\/\/stage.myliquis.co\/great_destinations\/patient-forms\/","title":{"rendered":"Patient Forms"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"2449\" class=\"elementor elementor-2449\" data-elementor-post-type=\"page\">\n\t\t\t\t<div data-particle_enable=\"false\" data-particle-mobile-disabled=\"false\" class=\"elementor-element elementor-element-78cdfda e-flex e-con-boxed e-con e-parent\" data-id=\"78cdfda\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div data-particle_enable=\"false\" data-particle-mobile-disabled=\"false\" class=\"elementor-element elementor-element-2a99efb e-con-full e-flex e-con e-child\" data-id=\"2a99efb\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t<div data-particle_enable=\"false\" data-particle-mobile-disabled=\"false\" class=\"elementor-element elementor-element-3f6860d e-con-full e-flex e-con e-child\" data-id=\"3f6860d\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-b487614 elementor-widget elementor-widget-heading\" data-id=\"b487614\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Patient Forms<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-62dec7d elementor-widget elementor-widget-text-editor\" data-id=\"62dec7d\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>To help save time during your visit, we\u2019ve made our most commonly used forms available for download. You can fill them out at home and bring them to your appointment.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div data-particle_enable=\"false\" data-particle-mobile-disabled=\"false\" class=\"elementor-element elementor-element-0dce91e e-con-full e-flex e-con e-child\" data-id=\"0dce91e\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-8b36dd8 elementor-widget elementor-widget-image\" data-id=\"8b36dd8\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img fetchpriority=\"high\" decoding=\"async\" width=\"1200\" height=\"800\" src=\"https:\/\/stage.myliquis.co\/great_destinations\/wp-content\/uploads\/2025\/10\/752A4738.webp\" class=\"attachment-full size-full wp-image-394\" alt=\"\" srcset=\"https:\/\/stage.myliquis.co\/great_destinations\/wp-content\/uploads\/2025\/10\/752A4738.webp 1200w, https:\/\/stage.myliquis.co\/great_destinations\/wp-content\/uploads\/2025\/10\/752A4738-300x200.webp 300w, https:\/\/stage.myliquis.co\/great_destinations\/wp-content\/uploads\/2025\/10\/752A4738-1024x683.webp 1024w, https:\/\/stage.myliquis.co\/great_destinations\/wp-content\/uploads\/2025\/10\/752A4738-768x512.webp 768w\" sizes=\"(max-width: 1200px) 100vw, 1200px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div data-particle_enable=\"false\" data-particle-mobile-disabled=\"false\" class=\"elementor-element elementor-element-44536ca e-flex e-con-boxed e-con e-parent\" data-id=\"44536ca\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div data-particle_enable=\"false\" data-particle-mobile-disabled=\"false\" class=\"elementor-element elementor-element-296e1a1 e-con-full e-flex e-con e-child\" data-id=\"296e1a1\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-3bc5b62 elementor-widget elementor-widget-heading\" data-id=\"3bc5b62\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">How to Fill Out Your Forms:<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-35ff7a5 elementor-widget elementor-widget-text-editor\" data-id=\"35ff7a5\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<ul class=\"ul1\"><li class=\"li1\"><b>Digital Option:<\/b>\u00a0Forms can be completed on your computer, then printed and signed.<\/li><li class=\"li1\"><b>Handwritten Option:<\/b>\u00a0If you prefer to fill out forms by hand, please use\u00a0black ink only\u00a0(no gel pens, please).<\/li><\/ul>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-e0a6a9b elementor-widget elementor-widget-heading\" data-id=\"e0a6a9b\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">New Patient Forms<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-e2e6425 elementor-widget elementor-widget-text-editor\" data-id=\"e2e6425\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\tIf you&#8217;re new to Great Destinations Pediatrics, please complete the following before your first visit:\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-1ffe271 elementor-widget elementor-widget-text-editor\" data-id=\"1ffe271\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<ul class=\"ul1\"><li class=\"li1\"><span class=\"s1\"><a href=\"https:\/\/stage.myliquis.co\/great_destinations\/wp-content\/uploads\/2026\/01\/NP-PAPERWORK-PACKET-2025.pdf\" target=\"_blank\" rel=\"noopener\"><span class=\"s2\">New Patient Packet<\/span><\/a><\/span><\/li><li class=\"li1\"><span class=\"s1\"><a href=\"https:\/\/stage.myliquis.co\/great_destinations\/wp-content\/uploads\/2026\/01\/NEW-Demo-25.pdf\" target=\"_blank\" rel=\"noopener\"><span class=\"s2\">Patient Registration Form<\/span><\/a><\/span><\/li><li class=\"li1\"><span class=\"s1\"><a href=\"https:\/\/irp.cdn-website.com\/b1cb3170\/files\/uploaded\/261644.pdf\" target=\"_blank\" rel=\"noopener\"><span class=\"s2\">HIPAA Authorization &amp; Release<\/span><\/a><\/span><\/li><li class=\"li1\"><span class=\"s1\"><a href=\"https:\/\/irp.cdn-website.com\/b1cb3170\/files\/uploaded\/261645.pdf\" target=\"_blank\" rel=\"noopener\"><span class=\"s2\">Consent for Treatment &amp; Testing<\/span><\/a><\/span><\/li><li class=\"li1\"><span class=\"s1\"><a href=\"https:\/\/irp.cdn-website.com\/b1cb3170\/files\/uploaded\/261665.pdf\" target=\"_blank\" rel=\"noopener\"><span class=\"s2\">Web &amp; Social Media Authorization<\/span><\/a><\/span><\/li><\/ul><p class=\"p2\"><strong>Patients 18 years and older:<\/strong>\u00a0Please complete the\u00a0<a href=\"https:\/\/irp.cdn-website.com\/b1cb3170\/files\/uploaded\/440983.pdf\" target=\"_blank\" rel=\"noopener\" data-wplink-edit=\"true\"><span class=\"s3\">Adult Patient Packet (18+)\u00a0<\/span><\/a>.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-6ddf2ce elementor-widget elementor-widget-heading\" data-id=\"6ddf2ce\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Records &amp; Billing Forms<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-7414e75 elementor-widget elementor-widget-text-editor\" data-id=\"7414e75\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p class=\"p1\">Use these forms to request records or manage your billing information:<\/p><ul class=\"ul1\"><li class=\"li2\"><span class=\"s1\"><a href=\"https:\/\/irp.cdn-website.com\/b1cb3170\/files\/uploaded\/420572.pdf\" target=\"_blank\" rel=\"noopener\"><span class=\"s2\">Release of Medical Records<\/span><\/a><\/span><\/li><li class=\"li2\"><span class=\"s1\"><a href=\"https:\/\/stage.myliquis.co\/great_destinations\/wp-content\/uploads\/2026\/01\/2022-NOTICE-OF-PRIVACY-PRACTICES-Omnibus-Rules.pdf\" target=\"_blank\" rel=\"noopener\"><span class=\"s2\">Billing Ledger Release<\/span><\/a><\/span><\/li><\/ul>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-7e43958 elementor-widget elementor-widget-heading\" data-id=\"7e43958\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Printable Office Forms<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-bb1f3a6 elementor-widget elementor-widget-text-editor\" data-id=\"bb1f3a6\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<ul class=\"ul1\"><li class=\"li1\"><span class=\"s1\"><a href=\"https:\/\/stage.myliquis.co\/great_destinations\/wp-content\/uploads\/2026\/01\/Demo-18YR.pdf\" target=\"_blank\" rel=\"noopener\"><span class=\"s2\">Patient Registration Form (18+)<\/span><\/a><\/span><\/li><li class=\"li1\"><span class=\"s1\"><a href=\"https:\/\/stage.myliquis.co\/great_destinations\/wp-content\/uploads\/2026\/01\/18-YR-PACKET.pdf\" target=\"_blank\" rel=\"noopener\"><span class=\"s2\">Patient Information Form (18+)<\/span><\/a><\/span><\/li><\/ul>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div data-particle_enable=\"false\" data-particle-mobile-disabled=\"false\" class=\"elementor-element elementor-element-1c52579 e-flex e-con-boxed e-con e-parent\" data-id=\"1c52579\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-7cb82535 elementor-widget elementor-widget-spacer\" data-id=\"7cb82535\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Patient Forms To help save time during your visit, we\u2019ve made our most commonly used forms available for download. You can fill them out at home and bring them to your appointment. How to Fill Out Your Forms: Digital Option:\u00a0Forms can be completed on your computer, then printed and signed. Handwritten Option:\u00a0If you prefer to [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"site-sidebar-layout":"no-sidebar","site-content-layout":"page-builder","ast-site-content-layout":"full-width-container","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"disabled","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"default","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"set","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":"","_wp_rev_ctl_limit":""},"class_list":["post-2449","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/stage.myliquis.co\/great_destinations\/wp-json\/wp\/v2\/pages\/2449","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/stage.myliquis.co\/great_destinations\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/stage.myliquis.co\/great_destinations\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/stage.myliquis.co\/great_destinations\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/stage.myliquis.co\/great_destinations\/wp-json\/wp\/v2\/comments?post=2449"}],"version-history":[{"count":5,"href":"https:\/\/stage.myliquis.co\/great_destinations\/wp-json\/wp\/v2\/pages\/2449\/revisions"}],"predecessor-version":[{"id":4553,"href":"https:\/\/stage.myliquis.co\/great_destinations\/wp-json\/wp\/v2\/pages\/2449\/revisions\/4553"}],"wp:attachment":[{"href":"https:\/\/stage.myliquis.co\/great_destinations\/wp-json\/wp\/v2\/media?parent=2449"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}