Forms

Forms

New Patient Forms


Established Patient Forms

NEXPLANON 


Immunizations

Most schools and daycares in Washington State require a Certificate of Immunization Status (CIS) form for enrollment. Please allow two business days for our office to complete requests for immunization records or CIS forms.


School, Sports, and Camps

Please allow two business days (excluding weekends & holidays) for forms to be completed by an Allegro provider.

Sports Physical or Camp Health Forms

  • Physical/Medication Form 
  • To ensure that any health conditions are identified and addressed appropriately, the  Health History Questionnaire must be completed before a physical health form is signed by your doctor (if your child has not had a full wellness exam within the last 6 months)

Medication Authorizations 

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.


eTravel Clinic 

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.