New Patient

We have put together our registration form along with policy documents and our Notice of Privacy Practices in to one convenient registration packet! This packet also contains a medical release form that you can give to your previous doctor if you are transfering to MPA. 

New Patient Registration Packet

We are excited for you to join our family! Registration must be completed prior to the birth of newborn babies and prior to any appointments being scheduled. When you turn in your registration packet we ask for 48 hours to review everything and ensure proper data entry into our system. 

We will accept packets turned in by fax, in person, or email. Please note that this document contains very private information and we DO NOT use encrypted email. Also, most home emails such as yahoo, gmail, hotmail, etc from which the document will be sent are not encrypted either. This puts your private information at risk of being accessible to hackers. IF YOU ACCEPT THIS RISK, you may email your packet to us at registration@midlandpediatrics.com