Forms & Policies

Below is a list of new patient forms.  Please complete and bring to our office along with your current insurance card and driver's license.  If you are transferring from another office we will need that physician's name and address and the transfer of records form signed by the parent.  If patient if over the age of 18, we will need that patient to sign the request.

Please complete one Consent for Treatment form for each child coming to the practice.

©2019 Blanchard Valley Pediatrics. Site design by

Call Us (419) 424-1922