Welcome!

Step One:

Please call our office, 520-298-3383, to verify that we take your insurance, and to provide basic contact information.

Step Two: 

Fill out and submit required forms online (no need to print), from the convenience of your COMPUTER.  See blue box below for specifics. Please make sure to read the notices and consent forms, including our Billing and Payment Policy and Notice of Health Information Practices. 

Step Three

We will then notify you, via email, when we have uploaded and entered the information, so you can schedule an appointment for your child.   You can also email shot records to shots@calliepeds.com before your child's first appointment.  

ATTENTION:
Must use a computer,  NOT a mobile device, to

fill out forms.  

New Patient Packet

(one per family)

Use computer to fill out and e-submit.

OR

Print and fill out pdf by hand; then fax to 520-207-5475 or bring to office before appt.
Medical Records Release

(one per family)

OR

OR

OR

Consent for non-parent to bring child to appt
Notice of Health Information Practices

please read--also included in
New Patient Packet

Notice of Privacy Practices
Opt Out Form (optional)

OR

The New Patient packet includes four required forms that you can fill out conveniently at home, on your computer.   If you have more than one child, you can enter all their information in one packet.  Then, fill out and submit a Questionnaire for each of your children. 

Please fill out and submit the forms at least 2-3 days before your appointment, so we can have all the information available for your child's appointment.  If there's a glitch and you can't figure out what is missing or what should be entered, just put something in the box, e.g. N/A or SAME. 

 

NOTE:  We are contracted with a company called PDF FILLER that encrypts all the information that you submit, so it's very secure and compliant with privacy laws (HIPAA). Hopefully this will expedite your check-in process! 

 

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To Schedule An Appointment

Call 520.298.3383