New Patient Paperwork:

To register your child, please complete & submit the information below, prior to your child's appointment.

Alternatively, print and complete the New Patient Information Forms below, and fax (239-908-3593), mail, or email (reception@lanepediatrics.com) to the office, prior to your first appointment with Dr. Lane. Thank you.
RECORDS RELEASE FORM

If you are transferring to Lane Pediatrics, please complete the Records Release Form and send to your previous pediatrician to have your records mailed to our office.
School Physical Forms:
There will be a $5 fee for physical and/or vaccine forms that are requested at a time other than your child's physical exam; this includes sports physical and camp physical forms. Forms will be ready within 2-3 days for pickup.

If you provide an addressed, stamped envelope, we can mail the forms to you or the school. If you need forms prepared the same day as requested, there will be a $20 rush fee, and the form will be ready by the end of the work day.

Please make sure that you or your child have completed all applicable sections of the forms before you drop them off to us for completion!
SCHOOL DISTRICT FORMS

If you need medical clearance for your child to play sports or be provided medication at school, please print and fill-out the applicable portions of the correct form, and bring to your visit with Dr. Lane.
LEE COUNTY SCHOOL DISTRICT FORMS
COLLIER COUNTY SCHOOL DISTRICT