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WASHINGTON UNIVERSITY CLINICAL ASSOCIATES

Forest Park Pediatrics

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Forms

Medical Records Request

  • Request a Copy of Your Medical Records (for yourself) (PDF)
  • Request Medical Records Release (to a third party) (PDF)

Consent and Communication 

  • Consent to Treatment (PDF)
  • Patient Communication (PDF)
  • Email and Text Authorization Form (PDF)
  • Telehealth Consent to Treatment: PDF; Doc

Additional Forms

  • Pediatric Update (PDF)
  • Missouri MSHSAA – Sports Participation (PDF)
  • Illinois IHSA – Sports Participation (PDF)
  • Concussion Screen (PDF)
  • Vanderbilt Assessment Scales (PDF)

Forest Park Pediatrics

Washington University Clinical Associates (WUCA)

4488 Forest Park Avenue

Suite 230

St. Louis, MO, 63108

314-535-7855

©2023 Washington University in St. Louis