Flu vaccine consent forms
Pediatric Flu Vaccine Consent Form
Adult Flu Vaccine Consent Form
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 info@premierforkids.com. 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.
Pre-Participation Forms:
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 PPE Form 2026
- 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. Please allow 7 business days after your form has been submitted to the office, for the paperwork to be completed. Forms needed in 24-48 hours will incur an expedited fee of $20.00
- Boy Scout Form
- KS PPE Form 2026
- KS Department of Health and Enviorment Daycare Health/Immunization form
- KS Certificate of Immunization (for public school)
- KS Asthma Action Plan (for public school)
- MO Pre-Participation Physical Evaluation form
- MO Child Medical Examination Report
Our office is happy to provide families with letters that may be necessary for various reasons. Below is a list of letters and the charges associated with producing the letters. Please allow 14 business days for letters to be completed. For “non-routine” letters that require a turnaround of 72 hours or less, there will be a $20.00 fee to expedite the processing of the letter that must be paid at the time the request for the letter is made.
$10.00
Standard ADHD (if we did NOT diagnose), 504 and IEP high school, middle school, Elementary
version
Social Security, passport
$20.00
ESA
Clearance for military
ACT accommodations
Letter of Medical Necessity
Insurance coverage- formula
Diagnosis letter for specialty services (ex: ABA)
Travel letters (ex: trying to get park quick pass)
Exemption- school, dietary restrictions, school late start, jury duty
Specialty beds/equipment/vehicles
Altered immunization schedule other than our standard option & vaccine schedule changes
Letter of appeal
Special accommodations
HAS/HRA/FSA/ diagnosis for coverage
Need to change schools
Sports clearance
Adoption letter
$25.00
Guardianship paperwork
FMLA paperwork