myPersonalChart :Review

You must review and accept the following:

*1. Kids Care Pediatrics's Consent for NJ immunization
	I have read and understood Kids Care Pediatrics Consent for NJ immunization (English / Spanish)
*2. Kids Care Pediatrics's Consent for Treatment
	I have read and understood Kids Care Pediatrics Consent for Treatment (English / Spanish)
*3. Kids Care Pediatrics's Information Release Form
	I have read and understood Kids Care Pediatrics Information Release Form (English / Spanish)
*4. Kids Care Pediatrics's NEW JERSEY IMMUNIZATION INFORMATION SYSTEM
	I have read and understood Kids Care Pediatrics NEW JERSEY IMMUNIZATION INFORMATION SYSTEM (English / Spanish)
*5. Kids Care Pediatrics's Notice of Privacy Policy
	I have read and understood Kids Care Pediatrics Notice of Privacy Policy (English / Spanish)
*6. Kids Care Pediatrics's Telemedicine
	I have read and understood Kids Care Pediatrics Telemedicine (English / Spanish)
*7. Kids Care Pediatrics's VACCINE POLICY ACKNOWLEDGEMENT
	I have read and understood Kids Care Pediatrics VACCINE POLICY ACKNOWLEDGEMENT (English / Spanish)

I acknowledge that I have reviewed the Patient Registration Details and it is complete and accurate to the best of my knowledge.

I hereby authorize the information entered, to be released and to be used by for continued medical care or processing financial benefits.

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*Consent received from :
(Consent must be given by either parent or legal guardian.)

*Name :

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