Patient Forms

First Steps Pediatrics needs to maintain updated files on all our patients. The following documents help us to ensure that we have a complete understanding of our patients, their medical history, and how to best treat their needs. Please feel free to download these files and complete them in advance of your first visit with us. This will enable you to complete all the information necessary, while also making your initial visit a bit easier. Thank you!


PA Offices

 WV Office

You can download the complete patient package of documents or select from individual files from the links below.
 Complete Patient Pack  Complete Patient Pack
 New Patient Information  New Patient Information
 Patient Registration Form  Patient Registration Form
 Past Medical History  Past Medical History
 Treatment Authorization Form  Treatment Authorization Form
 First Steps’ Financial Policy  First Steps’ Financial Policy
 Privacy Practice Notice 2017  Privacy Practice Notice 2017
 Authorization Form  Authorization Form
 Insurance Verification Form  Insurance Verification Form
 Medical Information Releases  Medical Information Release
 VFC Eligibility Form  VFC Eligibility Form
   Steubenville Relocation Packet