We are excited that you have chosen My Kid's Doc of Southfield for your child's medical care. Your comfort and convenience are our priority, and we strive to make every visit to our office a positive experience. To help you get acquainted with our office and first visit procedures, we have included helpful information on this page.
Our Mission
Our practice is working together to build life-long relationships between our staff and our patients by consistently providing our patients with compassion, excellence and value. To fulfill this mission, we are committed to:
- Improving the lives of the children we serve by providing quality care in a child-centered environment.
- Listening to our young patients and their families who we are privileged to serve.
- Guiding our patients along a path of optimal health and wellness.
- Continually pursuing excellence at all levels through continuing education.
If you're preparing for your child's first visit, you can do a few things to help expedite the appointment. Please provide the following information when you arrive for your visit:
- Insurance cards
- Complete immunization records
- Medical records from your previous pediatrician
We require proper identification and all current insurance information be verified at every visit.
Patient Forms
We are happy to provide our office forms for convenient download on your home computer. Please print and complete the forms below, and bring them with you to your child's first appointment. Questions about which forms you need? Please call our office and our courteous staff will assist you in preparing for your child's first visit.
- Pediatric Information Form [PDF]
- Pediatric Information Form (Online)
- Medical History Form (Online)
- Pediatric Health History [PDF]
- Pediatric Health History (Online)
- Patient Demographics Form [PDF]
- Electronic Prescriptions Form [PDF]
- Authorization and Agreements of Medical Treatment [PDF]
- Authorization and Agreements of Medical Treatment (Online)
- HIPAA Notice of Privacy Practices [PDF]
- HIPAA Notice of Privacy Practices Page 2 [PDF]
- Third Party Consent for Treatment and Examination [PDF]
- MHSAA Athletic Form [PDF]
- Michigan Health Appraisal Form [PDF]
- Michigan Health Appraisal Form (Online)
In order to view or print these forms you will need Adobe Acrobat Reader installed. Click here to download it.
The Initial Visit
Our compassionate city pediatricians do whatever it takes to make every visit to our office a pleasant, relaxed experience. With all of the important information about our practice available on our website, you can feel confident that you and child are well-prepared for your first appointment. We also invite you to review our staff page in order to get to know our doctors and staff. We look forward to meeting you.