Remember, to communicate with us through the web or by e-mail, you must first have signed an e-mail consent form in our office. If you e-mail us without first giving us your written consent, we will be unable to respond to or act on the message. Please enter the following information: Child's name: Child's date of birth: Records needed: daycare physical form immunization records school/camp/sports physical form growth charts other (specify below) Comments: Where should we send them? Your name: Your email address: Click here to send: Return to our home page Last revised 5/14/04 (C) 2003, Plateau Pediatrics, PLC. Contact us. Please view important information about this web site.
Remember, to communicate with us through the web or by e-mail, you must first have signed an e-mail consent form in our office. If you e-mail us without first giving us your written consent, we will be unable to respond to or act on the message. Please enter the following information: Child's name: Child's date of birth: Records needed: daycare physical form immunization records school/camp/sports physical form growth charts other (specify below) Comments: Where should we send them? Your name: Your email address: Click here to send:
Please enter the following information:
Child's name: Child's date of birth: Records needed: daycare physical form immunization records school/camp/sports physical form growth charts other (specify below) Comments: Where should we send them? Your name: Your email address:
Child's name:
Child's date of birth:
Records needed: daycare physical form immunization records school/camp/sports physical form growth charts other (specify below)
Comments:
Where should we send them?
Your name:
Your email address:
Click here to send:
Return to our home page
Last revised 5/14/04
(C) 2003, Plateau Pediatrics, PLC. Contact us. Please view important information about this web site.
