Lev Pediatrics
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Step 1 of 12 ~10 min remaining
New patient intake

Let's get to know your child.

This takes about 10 minutes. You can step away anytime — we'll save your progress automatically. If anything here feels unclear or doesn't apply, skip it and we'll sort it out together at your visit.

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01

About your child

The basics. We'll call them by their preferred name at every visit.

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02

Home address

Your home address.

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03

Parents & guardians

The adults we'll loop in for care. At least one is required. Both, if applicable.

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04

Emergency contact

Someone we can reach if a parent is unavailable. Can be a grandparent, neighbor, or family friend.

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Required
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05

Pregnancy & birth

If your child is over 3, you can skip anything you don't remember. For infants, this helps us pick up where the hospital left off.

06

Medical history

Tap any conditions your child has been diagnosed with.

07

Allergies

Anything your child reacts to. Food, medications, environmental, or other.

08

Current medications

Include prescriptions, daily vitamins, and anything given regularly.

09

Immunizations

The fastest way: snap a photo of your child's vaccination record. We'll transcribe it.

10

Family health history

Conditions in your immediate family (parents, siblings, grandparents). This helps us screen proactively.

11

Day-to-day

A few quick questions that help us meet your child where they are.

You're all set.

Thanks for trusting us with this. We will review everything before your visit.

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