Fillable Forms
For your convenience, we’ve made our patient forms available online. You can download and print the forms at home, fill them out, and bring them with you to your appointment. Completing your paperwork ahead of time helps us streamline your check-in process and allows our providers to see you more quickly.
If you prefer, all forms can also be completed in our office on the day of your visit. Please plan to arrive a little earlier than your scheduled appointment time to allow enough time to fill them out.
To help us get to know your family, please complete the following forms before your first visit. You may:
- Fill them out on your computer and print,
- Print and complete by hand, or
- Arrive a little early to complete them in our office.
- Privacy Policy
Please take a moment to read our Privacy Policy.
For review only—you do not need to print or sign this form. - Policies Form (2 pages)
Download the Policies Form and complete one for each of your children. - New Patient Medical History Form (1 page)
Download the Medical History Form and complete one for each of your children. - Patient Registration Form (1 page)
Download the Patient Registration Form and complete one for each of your children.
In certain situations, we need written permission before we can see your child without a parent present. Please complete the form that applies to your family:
- Authorization for Minor Consent (Teens 15 and older)
If your teen (15+) will arrive on their own or be dropped off, please complete the Authorization for Minor Consent Form. - Authorization for Non-Parent to Bring Child
If someone other than a parent (such as a grandparent, relative, or family friend) will be bringing your child, please complete the Non-Parent Authorization Form. - Caregiver Authorization Affidavit
Complete this form if a parent is unreachable or unavailable to sign the form above and another adult is able to bring the child. Please bring a legal ID for us to copy. Caregiver Authorization Affidavit. - Medical Records Release & Request Form
Complete this form if you need us to request medical records from another provider (such as immunization records, growth charts, or prior medical history), or if you would like us to send records to another office. Medical Records Release Form.
School Forms
Schools and athletic programs often require medical clearance forms before your child can participate in classes, sports, or extracurricular activities.
These forms help with school enrollment and medical care while your child is at school.
- Physician’s Report – Childcare Centers
Required for daycare, preschool, or childcare enrollment. - Report of Health Examination (“Kindergarten Enrollment Form”)
Required by California law when a child first enters TK, Kindergarten, or 1st grade. - Shots for School
Shots for School provides California’s current immunization requirements for school entry.
- Teen Physical (Age 12 and up)
- A routine physical form recommended for all teens, even if they do not participate in sports.
- We ask you to complete the sports physical form below at your child’s yearly physical, even if they do not participate in sports.
- Sports / Physical Forms
- Needed for school athletics. If your child may participate in a sport, please complete both the physical form and as much as you can on the clearance form. We will sign the clearance form at your child’s physical.
- Instructions – How to Complete the Sports/Physical Form
- Sports/Physical Form – English
- Sports/Physical Form – Spanish
- Sports Clearance Form
Tip: If your school uses “Register My Athlete” or similar systems, you may print and bring those forms for review instead.
- Needed for school athletics. If your child may participate in a sport, please complete both the physical form and as much as you can on the clearance form. We will sign the clearance form at your child’s physical.
Please complete these as fully as possible before dropping them off.
- Asthma – medication authorization for albuterol
- Anaphylaxis – medication authorization for epinephrine, Benadryl, and albuterol
- Medication authorization form – blank
- MD order readmission with temporary precautions
- Medical verification for special diet
Starting at Coastal Pediatric Medical Group is an exciting step in your child’s healthcare journey — and we know it often comes with plenty of questions (which we’re always happy to answer!). Our FAQ page is designed to guide new patients and families through everything from scheduling appointments and navigating insurance to understanding our pediatric services and billing process. Whether you find the answers you need online or connect with our warm and welcoming staff, we’re here to make the transition easy and ensure your child’s care gets off to a healthy, happy start.
We understand that billing and insurance aren’t anyone’s favorite part of healthcare. That’s why our knowledgeable billing team is here to make the process as simple and stress-free as possible. Well-versed in a wide range of insurance plans and payment options, we work to ensure your family can easily access the care your child needs. Our priority is a smooth, worry-free experience, so you can focus on what matters most: your child’s health.
Our Locations
With two welcoming clinic locations in Ventura and Oxnard, Ventura Coastal Pediatrics makes it easy to access exceptional pediatric care close to home. Whether you’re in the heart of Ventura or the surrounding area, our caring team is here to support your child’s health and wellness every step of the way.
Mon – Fri: 8:30-12:00 & 1:30-5:00
Mon – Fri: 8:30-12:00 & 1:30-5:00
