Forms
Administrative Forms
Medical Records Release Form (New Patient)
Medical Records Release Form (Transfer)
School 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 working days to complete the form.
IHSAA Pre-participation Physical Evaluation (PPE) Form
FSSA Childcare Form – Physical Form for Child – State Form 49969
Information & Form Submissions
New Insurance Card submission: ins@meridianpediatrics.net
Outside Test Result submission: office@meridianpediatrics.net
School & Camp Forms: forms@meridianpediatrics.net
Medical Records Requests (for families leaving the practice, for personal use, or for those who have aged out of the practice): records@meridianpediatrics.net