Office Policy Handouts

Registration Forms
  • 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.
Office Policy Handouts
Health Care Forms
  • 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 (forms@stapletonpeds.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 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 (forms@stapletonpeds.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.
Denver Pediatrics

What Our Patients Say:

I love this place they are always friendly and their priority is about the kids that come in and to the family as well. I started coming her for the past four years or so and I love it. The doctor my kids see is Danny and he is the sweetest dr my boys have ever had and they do not cry with him and the place I was going to before both my kids would cry and did not like going to the dr. I highly recommend this pediatric to anyone. Nicole Aug 23,2015

Stapleton Office

2975 Roslyn Street
Suite 100
Denver, CO 80238

303-399-7900
FAX: 303-399-7999

MONDAY-FRIDAY: 8am to 5pm
SATURDAY: 8am to 12:30pm

  • Sick Visits only on Saturdays
  • Our Denver pediatrics office is closed every day from 12:30-1:30 for lunch
  • We are closed on major holidays
Mother and kids with giraffe at zoo

Pearl Street Office

1258 South Pearl Street
Suite 110
Denver, CO 80210

303-399-7970
FAX: 303-399-7905

MONDAY-FRIDAY: 8am to 5pm 
SATURDAY: Closed

  • Saturday sick appts seen at Stapleton Pediatrics office only
  • Our office is closed every day from 12:30-1:30 for lunch
  • We are closed on major holidays
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