352-589-8111

Lake Pediatrics
4880 North Highway 19a Suite 200
Mount Dora, FL 32757
Phone:352-589-8111
Fax:352-589-8495

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View the KidsDoc Symptom Checker from HealthyChildren.org

An online resource center providing you with additional helpful information.

Choosing a pediatrician is an important and personal decision and we want you to feel at ease with the care you and your child will receive.

 

We are happy to provide our office forms for convenient download on your home computer. Please print and complete the forms below, and bring them with you to your child's first appointment. Questions about which forms you need? Please call our office at 352-589-8111, and our courteous staff will assist you in preparing for your child's first visit.

New Patient Forms

(Please fill out and bring to your initial office visit.)

 

Yearly Patient Information Update Form

(Please fill out yearly to update demographics and sign for consent to treat.)

 

Ages and Stages Questionnaires

(Please fill out and bring to Well Checks/Physicals for the listed ages.)

 

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

Questions or Comments?
We encourage you to contact us whenever you have an interest about our services.

Call 352-589-8111

4880 North Highway 19a, Suite 200
Mount Dora, FL 32757