Forms

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.

To help expedite your first visit, either complete the secure online forms below OR print, fill-out and bring the Registration Form and Patient Chart Request Form to our office at the time of your appointment. The Patient Financial Policy and Notice of Privacy Policy are important to review and understand prior to your first appointment.

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.

Click here to Securely Upload a File

Denver Pediatrics

What Our Patients Say:

This is the place to go. My daughter has a serious medical condition that has been diagnosed for the last year. We work with Children's on an regular basis but Norkio has been our life saver. Norkio advocate for my daughter with many different department at children's, oxygen companies, OT and PT's and is always happy to do so. Amy Nash is always there to fight the fight if Noriko is not. After sending us to the ER one Friday afternoon Danny called to check on us, not just on Friday but on Saturday and Sunday as well! I have never heard of a provider doing that. Countless times I have run in with my daughter having oxygen problems and been terrified, but the team at Stapleton Peds always eases my fears and takes remarkable care of my children. Rashima at the front desk is wonderful and just hearing her voice eases the panic. I just want to name everyone and mention something special about them but there are just too many special things about this practice. Katie M Nov 29,2016

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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