HIPAA Acknowledgement

Step 1: Download this form and read thoroughly for your right to privacy under HIPAA: HIPAA Notice Brochure

Step 2: Please eSign this form and save it to your computer, or print, sign and scan this form to your computer. You will need to upload it to the form below: HIPAA Acknowledgement Form

Please print and complete the appropriate forms below. Please email them to info@alzeinpeds.com and bring them to your first appointment. If you have any questions, please arrive a few minutes early so our staff can assist you.

Thank you!

In order to view or print these forms you will need Adobe Acrobat Reader installed. Click here to download it.

CDC VACCINE INFORMATION STATEMENT

CDC Vaccine Schedules / Vaccine Information Statement Sheets:

Child and Adolescent Immunization Schedule for ages 18 years or younger
Catch-up immunization schedule for persons aged 4 months – 18 years

VIS-English:

Main Website

Vaccine Schedule 0-18 years:
VIS-Arabic:

Main Website

Vaccine Schedule 0-18 years:
VIS Spanish:

Main Website

Vaccine Schedule 0-18 years:
Newsletter Icon
Get Our E-Newsletter