Welcome! We are thrilled and honored that you have chosen Stapleton Pediatrics or Pearl Street Pediatrics to provide healthcare for your child.
We take great pride in offering the highest quality, team oriented and personalized healthcare for newborns, children, and teens. If you haven't already, please contact us to schedule an appointment, and be sure to read about our Care Team Approach.
Registration Form (Secure PDF Form)
Please review the Notice of Privacy Practices and Notice of Privacy Practices prior to submitting your registration form. By submitting this form online, you are agreeing to abide by these terms.
Patient Chart Request Form (Secure PDF Form)
This form is for medical records only - for school and day care forms see Health Care Forms.
Delegation of Medical Care (PDF)
Our Delegation of Medical Care Form allows parents to provide consent for another adult to bring your child into the office and make associated health care decisions. We do require a parent (or legal guardian) be present with valid ID to establish the consent before we will allow another care provider to bring a child in.
General Health Appraisal (PDF)
Please fill out the parent section prior to sending us the General Health Appraisal. Once completed this form can be dropped off at the office, faxed (303-399-7988), emailed (firstname.lastname@example.org) to us, or uploaded through our Secure Online File Upload for completion. Please allow 3 business days for us to finish the form and we can return it to you or your daycare provider. If you will not be picking the form up in person, please provide any instructions for where the form is to be sent with your request.
Allergy Care Plan (PDF)
The Allergy Care Plan is approved for use by most school districts and camps in the Denver metro area. If you child requires a form to be completed for attendance please fill in the top section and it can be dropped off at the office, faxed (303-399-7988), emailed (email@example.com) to us. or uploaded through our Secure Online File Upload for completion. Please allow 3 business days for us to finish the form and we can return it to you.
Sports Pre-Participation History Form (PDF)
The Sports Pre-participation History Form is helpful to complete and bring with you to your child’s annual or sports physical exam.