New Patient Forms

Thank you for putting your trust in our clinic - We're happy you're here.

If you're a first-time visitor to Russellville Pediatric & Adolescent Clinic, you'll need to fill out these forms in their entirety. To help expedite your visit, you can download the forms linked below, print them, and fill them out in advance. Otherwise, please arrive up to 15 minutes early to your appointment and fill these out at our clinic.

• Initial History Questionnaire
• Patient Registration Form
• RPAC Financial Agreement
• RPAC HIPAA Form
• No Show or Cancellation Policy
• RPAC Medical Release