Mandatory Office Consent Form

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Thank you for entrusting us with your child’s healthcare. To ensure a transparent and positive experience for all our patients, we require that every family review and acknowledge our office policies.

This consent form includes our policies on:

  • Financial Responsibilities
  • HIPAA Privacy Practices
  • Healthix Health Information Exchange
  • Consent for Treatment

Please review the form carefully. Our team is happy to answer any questions you may have!

View our Heights Pediatrics Office Consent Form here!

Financial Policy, HIPAA, Healthix, Consent to Treat Form


As of 1/6/2025, we ask for all patients to respond regarding the Patient Service Plan [more info here]