Look here for URGENT announcements and updates!

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    • AAP Healthy Children.org
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    • CDC Vaccine Info. Sheets
  • Insurance and Fees
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  • Useful Links
  • More
    • Home
    • About
    • Gallery
    • Providers & Staff
    • Our Services
    • Emerald program
    • Patient resources
      • AAP Healthy Children.org
      • CDC Vaccine Schedule
      • Forms
      • Vaccine Policy
      • CDC Vaccine Info. Sheets
    • Insurance and Fees
    • Becoming a New Patient
    • Useful Links

  • Home
  • About
  • Gallery
  • Providers & Staff
  • Our Services
  • Emerald program
  • Patient resources
    • AAP Healthy Children.org
    • CDC Vaccine Schedule
    • Forms
    • Vaccine Policy
    • CDC Vaccine Info. Sheets
  • Insurance and Fees
  • Becoming a New Patient
  • Useful Links

Patient Forms

Patients, that have ALREADY been accepted into the practice, may print these forms and bring them to their first visit.

Authorization and Consent for Treatment Form (pdf)

Download

Authorization for Release of Medical Information Form (pdf)

Download

Preferred Contacts Form (pdf)

Download

office Policies

For your review as a patient of our clinic

Financial_Policy (pdf)Download
Notice_of_Privacy_Practices_8042 (pdf)Download
Virtual_Visit_Tech_Policy (pdf)Download

Office policies

Please review all office policies
HIPAA Privacy NoticeVaccine policyLanguage services

Additional Patient Forms

Current patients may access them through the portal. Print a
my privia portal

Dragonfly Pediatrics is a proud member of Privia Medical Group.

 https://www.priviahealth.com/


The best Providers in our community have joined together to form Privia Medical Group (PMG), a multi-specialty, high-performance medical group that puts patients first. Our Providers are united by the mission of providing better, more coordinated care for their patients.

To learn more about PMG and find other Privia Providers, please visit our website.

 

  • “Notice of Nondiscrimination” linking to http://www.priviahealth.com/notice-nondiscrimination/
  • “HIPAA Privacy Notice” linking to https://www.priviahealth.com/privacy-and-compliance/
  • “Press Room” linking to https://www.priviahealth.com/newsroom/
  • “Prospective Doctors” linking to https://www.priviahealth.com/who-we-support/physicians/