The following forms are for your benefit. Please download the form or copy

 and print and bring this form with you at your next scheduled visit. 

Please note:  All school forms, preschool forms, sports forms, medication forms, work permits, etc., will

be completed free of charge if presented at the time of your child's well care exam.  There will be a

charge of $5.00 per form completed at any time other than during the well care exam. 

• Pre registration form page 1 Acrobat Adobe format

• Pre registration form page 2 Acrobat Adobe format

• Children's Hospital  Pre-OP Form. pdf  

• Ohio High School Sports Physical form 

• Authorization to release Medical records to Muddy Creek Pediatrics

• Authorization to release Medical  records from, Muddy Creek Pediatrics