Dear Parents,

The doctors and employees at TLC Pediatrics Medical Group want to welcome you to our practice. We strive to maintain satisfaction for each visit and to continually deliver quality medical services to your family.

In order for us to provide the quality of care you expect and deserve, there are some administrative steps to take before your appointment. Please complete the forms below and bring them with you on the day of your appointment.

Please bring your medical insurance card and any medical reports from other physicians if applicable. Please keep us informed every time your medical insurance carrier changes. Note: all co-pays, deductible or non-covered services are payable at the time of your visit.

For you convenience, we accept Visa, MasterCard, American Express, debit cards, cash, checks or money orders. If you have questions in regard to filling out the forms, please arrive 10 minutes prior to your appointment.

NOTE: To print individual forms, please open the form document, then scroll to the form you want. Go to file – print and then click the “Current Page” button. Then press OK and it will print only that form that is on the screen.


Forms for New Patients - Please open the file and print the forms. Then fill them out and bring them to your first visit.

New Patient Package


Change Information Forms - Print the form and fill in any information that has changed. Bring this with you on your next visit.

Change of Information

School Examination Report Form

TLC Pediatrics
Hours: Monday-Friday Call from 8:30 am
to 5 pm

(949) 493-1418

After Hours Care

Daily after 5pm

Saturday, Sunday
10 am to 9 pm

Major Holidays
10-6 pm
(949) 682-4750