Patient Forms

Patient Forms

Coast Pediatrics Del Mar

Records Release Form – To Coast Pediatrics
Records Release Form – From Coast Pediatrics

Coast Pediatrics Carmel Valley

Records Release Form – To Coast Pediatrics
Records Release Form – From Coast Pediatrics

To obtain a copy of your child’s medical records, please download and print the form above,
filling out a separate form for each child. Give this form to your previous pediatrician and select
whether you would like the records released directly to you or sent to Coast Pediatrics.
We recommend that you pick up the records yourself to minimize the chance of delays in our
receiving records. Make a copy for yourself and bring the records with you on your first visit to
our office.

Financial Policy
Notice of Privacy Practices

Please review the above forms prior to your visit in our office. You will be asked to sign these
forms at your first visit, and annually thereafter.