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Simulated Clinic Website: lakeshorepeds.com

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https://www.lakeshorepeds.com/patient-forms-and-intake

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Lakeshore Pediatric & Adolescent Medicine

Multi-Site Pediatrics & Urgent Care • Evanston, IL • Accepting Medicare & Medicaid

Download Required Patient Registration & Medicare Forms

Please download and complete these PDF forms prior to your appointment at Lakeshore Pediatric & Adolescent Medicine:

Pediatric Family Registration & Medicaid CHIP Intake

File: Newborn_Child_Registration_2026.pdf

📄 Download Patient Form (Newborn_Child_Registration_2026.pdf)

CDC / AAP Childhood Immunization Table & Consent

File: Immunization_Schedule_Consent.pdf

📄 Download Patient Form (Immunization_Schedule_Consent.pdf)

Adolescent Sports Physical & Asthma Action Plan

File: School_Sports_Physical_Form.pdf

📄 Download Patient Form (School_Sports_Physical_Form.pdf)