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 2024
- 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.
- Boy Scout Form
- KS PPE Form 2024
- 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
Patient Letters
Our office is happy to provide families with letters that may be necessary for various reasons. 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 $10.00 fee to expedite the processing of the letter that must be paid at the time the request for the letter is made. Examples of “non-routine” letters are listed below.
- Standard ADHD 504 & IEP for high school, middle school, and elementary school
- Social Security
- Passports
- ESA
- Clearance for Military
- ACT accommodations
- Letter of Medical Necessity
- Insurance coverage
- Diagnosis letter for specialty services (ex: ABA)
- Travel Letters
- Exemption letters (ex: school late start, jury duty, etc.)
- Specialty beds/equipment/vehicles
- Altered immunization schedule
- Letters of appeal
- Special accommodations
- HSA/HRA/FSA, diagnosis for coverage
- Letters indicating the need to change schools
- Adoption letters
- Guardianship paperwork
- FMLA**
**Family Medical Leave Act (FMLA) can also be completed by our office if you are needing to take time away from work to care for your child. A $25.00 processing fee is due before the paperwork will be filled out.