Premier Medical Forms:
Please be patient, this form may take a minute to load in your browser. The patient registration form may be printed and returned to Premier Pediatrics at your next appointment or you may save and email the completed PDF to firstname.lastname@example.org. If you intend to complete this form on a Mac, you will need to print the form and bring it into our office as it does not email correctly. We apologize for any inconvenience.
Please complete this document and return it to Premier Pediatrics at your convenience.
The following Kansas and Missouri Pre-Participation forms include health history portions that are to be completed by the participant and parent or guardian. Our office requires this portion to be completed before we can provide clearance for the participant.
If your child will require pre-participation clearance, please complete and return the appropriate form to Premier Pediatrics at your child’s next physical appointment.
- KS Pre-Participation Physical Evaluation(Participant & Parent/Guardian portion only)
- MO Pre-Participation Physical Evaluation (Participant & Parent/Guardian portion only)
Commonly Used Health Forms:
We have compiled a list of download-able physical forms from local organizations and schools for your convenience. Most connect straight to a print-friendly PDF document.
- Boy Scout camp form
- KS Pre-Participation Evaluation Form – Full
- KS Department of Health and Enviorment Daycare Health/Immunization form
- KS Certificate of Immunization (for public school)
- KS Asthma Action Plan (for public school)