Drs. Black and Benton Pediatrics
  • New Patients
    • General Info
    • Philosophy
    • Coparenting & FAQ
    • New Patient Forms
    • COVID-19
  • Established Patients
    • Calling After Hours
    • Insurance Glossary
    • Yearly Physicals
    • Forms and Letters
  • Contact Us / Directions
New Patient Information
Our Location
     Office and Lab
     Accepted Insurance
     Your First Appointment

Our Philosophy of Care
     Mission Statement
​     Immunization Policy

Coparenting and FAQ
New Patient Forms
COVID-19

New Patient Forms

Download the new patient packet (zip).​
If zip is not a supported format, you can download the forms individually below.

We are required to update the Patient Registration and Consent form annually for every child in our practice.  If you would like to fill it out before your appointment you can download it below.  Note that patients over 18 years of age require a new registration and HIPAA form.
Patient Registration and Consent
18+ patient registration and consent
HIPAA Privacy Practices
18+ hipaa privacy practices
Transfer Records to Drs. B&B
Financial Agreement
Missed Appointment Agreement
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  • New Patients
    • General Info
    • Philosophy
    • Coparenting & FAQ
    • New Patient Forms
    • COVID-19
  • Established Patients
    • Calling After Hours
    • Insurance Glossary
    • Yearly Physicals
    • Forms and Letters
  • Contact Us / Directions