New Pediatric Patients
Thank you for choosing Pediatric and Adolescent Center as your child's medical home, where we always provide a comfortable, caring environment so our patients and their families can feel at ease. We've included helpful items on this page to ensure you and your child's first trip to our office is productive, stress-free and enjoyable.
Our Mission
Our mission is to provide the best possible care to our patients in the most efficient manner.
Patient Forms
To expedite your first appointment, please arrive a few minutes early to complete registration forms so that we have all the necessary information to treat your child. You may also download and print the forms from this website, fill them out ahead of time, and bring them with you to the first appointment. Please fill and sign all the following forms:
- Patient History & Information
- Consent to Treatment
- Policies & Procedures
- Agreement Page
- Patient Provider Agreement for PCMH
- Health Information Release Authorization
Other forms:
- HIPAA Privacy Notice
- School Physical Form
- Sports Physical Form
- Vanderbilt Rating Scale - Teacher Informant
- Vanderbilt Rating Scale - Parent Informant
In order to view or print these forms you will need Adobe Acrobat Reader installed. Click here to download it.
What to expect
On the day of your child’s first visit to our office, we recommend arriving a few minutes early. This allows extra time for finishing up any registration forms and ensures you have plenty of time to get acquainted with our staff and office. We look forward to meeting you and joining with you to help your child maintain optimal health.
Directions
Find Us
15555 Northline Rd
Southgate, MI 48195
(734) 285-3090
Quick Access
Sick Child?
Same day appointments!
Parent Resources
An online resource center providing you with additional helpful information.