Forms

New Patient Forms

HIPAA Form

Vanderbilt Forms

Flu Shots

School and Daycare Forms

Please email completed school and daycare forms to Forms@meridianpediatrics.net

Medical Records Release Form

Please email completed medical records request forms to records@meridianpediatrics.net. Be sure to complete one form for each patient and to clarify if the patient(s) are transferring out of Meridian Pediatrics to a new primary care doctor. Please allow up to 30 days for completion of requests.

Telemedicine Forms

Sick Appointment Policies

  • We are triaging all sick appointment requests before scheduling appointments;
  • We ask that siblings who don’t have appointments do not accompany the patient to the appointment if at all possible.
  • We require that anyone 3 years of age and older entering our office wears a mask;
  • We are offering telemedicine appointments for certain types of visits.

Saturday Appointments

  • From September to May, the office is open on Saturday mornings for same-day sick visits only.
  • Saturday office hours vary with doctors. Please call the office to verify weekly Saturday office hours.
  • Our clinical staff will triage sick visit calls to determine how best to schedule your appointments.

Telephone Calls

  • The doctors give medical advice during office hours.
  • When you call, the medical receptionist will carefully transcribe your concerns in a note to your doctor. The doctor will review the note and instruct the receptionist or nurse to advise you accordingly.
  • Insurance and billing questions will be accepted between 9:30 am and 4:30 pm.
  • If a photo review is appropriate and the physician returns your call, there may be a charge to insurance.

School and Camp Forms

  • Please note that most forms require a routine physical examination within the preceding 6-12 months.
  • Please fill out all requested information in the parent section.
  • It takes approximately 5 to 7 business days to complete the form.
  • There is a nominal charge due at time of request for the completion of this paperwork. An additional fee may be paid for expedited form completion.

Meridian Pediatrics
12065 Old Meridian St., Carmel, IN 46032
TEL: (317) 844 - 5351 - FAX (317) 844-0310