Forms

Forms

New Patient Forms


Established Patient Forms

NEXPLANON 


Immunizations

MyIR

Do you need a copy of your child’s vaccine records? Allegro Pediatrics participates in the state vaccine registry, and the Washington State MyIR program allows you to view and print your child’s vaccine records through the registry.


School, Sports and Camps

To ensure that any health conditions are identified and addressed appropriately, this questionnaire must be completed before a sports physical form is signed by your doctor.

Requirements vary by school district and program. Please confirm required forms and deadlines before scheduling an appointment. Links to the various Eastside school districts can be found here.


The eTravel Clinic is back!

Allegro Pediatrics offers pre-travel health consultations that are online, affordable and convenient. The eTravel service is offered at a cost of $60. Please note that, while we will bill your insurance, you will be responsible for this amount if the service isn’t covered.

Submit your completed eTravel Questionnaire to us either by fax or by dropping it off at any of our eight offices. Learn more here.


Academic/Behavioral Concerns

These forms may be requested before an appointment for academic/behavioral concerns for school-age children. Please fax the form to the clinic where your appointment is scheduled, 48 hours before your appointment.


Developmental Screening

This form is requested as part of the Well Child Check-up for 18 and 24 months, and it may be completed prior to the appointment.