Thank you for selecting A Place to Grow Pediatrics in Yukon, Oklahoma for your child’s care. To schedule an appointment with Dr. Trinity Loveless, Dr. Diana Farrow, Dr. Sarah Bratcher, Dr. Cathryn Merideth, Dr. Allison Scott or nurse practitioner, Leslie "Jenny" Whisenhunt, call us at (405) 265-3900.
Once you have made your initial appointment, you may pre-register by downloading, printing, and completing the forms below. Please be sure to bring them with you to your first visit. Completing the forms prior to your visit will help speed up the new patient registration process.
Downloadable Forms:
- New Patient Registration Packet
- Request for Medical Records
- Sports Physical Form
- HIPAA Privacy Policy
- Vanderbilt Assessment Scale
- M-CHAT Autism Screening
- Behavioral Health - Pediatric Screener
- Authorization for Treatment of Minor
- ASQ 2 Month
- ASQ 4 Month
- ASQ 6 Month
- ASQ 9 Month
- ASQ 12 Month
- ASQ 16 Month
- ASQ 18 Month
- ASQ 24 Month
- ASQ 30 Month
- ASQ 36 Month
- ASQ 48 Month
- ASQ 60 Month
Please note: It may take a few minutes to load the forms if you are using a slow internet connection. If you are unable to view the forms, you may need to download Adobe Acrobat for free by clicking on the icon below.
