Valerie Jacobson, MD Office and Other Patient Information
Office 1: Baptist Primary Care
, Jacksonville, FL 32217
Welcome to Baptist Pediatrics. To help expedite your first visit, we provide our health forms online so that you can print and complete them at your convenience. If you have any questions, please don’t hesitate to contact our office staff.
Baptist Pediatrics Forms
Authorization for Use of Voicemail
Authorizes Baptist Health to leave appointment, referral and test results information on your voicemail.
Authorizations and Acknowledgments
Information about Baptist Pediatrics’ policies, insurance/billing, authorization for treatment and more.
Baptist Pediatrics Health Care Status
Authorizes Baptist Pediatrics to release information concerning the status of your health care, including laboratory and radiology results and to discuss your treatment plan with an individual that you name.
Baptist Pediatrics Registration & Insurance Information
Captures patient demographic information, insurance information and authorizes Baptist Pediatrics to prepare and submit your medical bill directly to your insurance company.
Health Care Authorization & Consent For Treatment Of Minors
Authorizes Baptist Pediatrics to deliver medical services and treatment to your child.
Medical Records Release
Request to have your medical records sent to another medical provider.