AGE 15-17 YEAR FORMS

Your child must be 15 or older at the date of their scheduled appointment to complete these forms. 

Parent Please Complete:

Please Have Child Complete:

OR copy and text this link to them:  https://myupdox.com/portal/illinipediatricsllcdbaidealpediatrics2/html/publicform-52186.html

Fax: 618-281-8393 

PHONE HOURS: Monday-Friday 8:00-4:30,

Evening and Weekend Appointments Available

Evening and Weekend Appointments Available

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