Patient Forms

Please click on the appropriate form and fill out the form online. Your form will be automatically submitted to Dr. Atiga’s office.

• New Patient Registration Packet
• M-Chat
• Pediatric Sudden Cardiac Death Risk Assessment Form
• Staying Healthy Assessment 0-6 Months
• Staying Healthy Assessment 7-12 Months
• Staying Healthy Assessment 1-2 Years
• Staying Healthy Assessment 3-4 Years
• Staying Healthy Assessment 5-8 Years
• Staying Healthy Assessment 9-11 Years
• Staying Healthy Assessment 12-17 Years
• Consent toUse Telemedicine

Spanish Forms

• Declaración del Proveedor al Paciente
• Los Directivos Avanzados
• CUESTIONARIO “MANTÉNGASE SALUDABLE” (0-3)
• CUESTIONARIO “MANTÉNGASE SALUDABLE” (4-8)
• CUESTIONARIO “MANTÉNGASE SALUDABLE” (9-11)
• CUESTIONARIO “MANTÉNGASE SALUDABLE” (12-17)
• CUESTIONARIO “MANTÉNGASE SALUDABLE” (18+)
• Consentimiento Para Utilizar La Telemedicina

Additional Forms

• Consent to Treat Minor
• Authorization to Provide info to School or Child Care
• Consent to Share information
• Authorization for Disclosure of Medical Information from Dr. Atiga
• Authorization for Disclosure of Medical Information from another Doctor