Patient Forms

Willow Bend Pediatrics Vaccination Statement:

Effective immediately, Willow Bend Pediatrics will no longer accept new patient families who are unwilling to vaccinate in accordance to the American Academy of Pediatrics (AAP) vaccine schedule (

Exceptions to the AAP schedule are circumstances in which the child is experiencing an illness that is not compatible with vaccinating safely (cancer/leukemia, immune deficiency, or current fever or severe illness). Administration of the influenza (flu), the human papillomavirus (HPV/Gardasil) and Covid vaccines are strongly encouraged but subject to parental discretion.

We are also happy to offer you the option to download, print and complete our office forms to reduce wait times during your first appointment.

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