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

View map and directions

Patient Forms

 

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.


Patient Forms

These forms must be filled out and signed each year by the parent or legal guardian.


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.

An online resource center providing you with additional helpful information.

View the KidsDoc Symptom Checker from HealthyChildren.org

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.

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