# Forms

Source: https://arlingtonpediatrics.com/forms/
Published: 2014-05-27
Updated: 2026-01-21

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#### **Forms**

At APL, we strive to keep our patient families informed and up-to-date regarding our office policies, routine immunizations and more.

Below are a variety of forms (in .pdf format) for you to view and print.

**OFFICE POLICY FORMS\**[Missed Appointment Policy](https://arlingtonpediatrics.com/wp-content/uploads/2026/01/Missed-Appt-Policy.pdf)[\](http://apltd.spyrhost.us/wp-content/uploads/2014/05/Missed-Appointment-Form.pdf)[Notice of Privacy Practices\](https://arlingtonpediatrics.com/wp-content/uploads/2014/05/Notice-of-Privacy-Practices.pdf)[Insurance / Payment Details\](https://arlingtonpediatrics.com/insurance-payment-details/)[Immunization Schedule](https://arlingtonpediatrics.com/wp-content/uploads/2025/12/APL-appointment-immunization-schedule-updated-12.16.25.pdf)

**TRANSFER RECORDS TO APL\**[Records Release Form](https://arlingtonpediatrics.com/wp-content/uploads/2019/04/Release-of-Records-4.17.19.pdf)

#### **We’re Here To Help**

If you have any questions regarding our forms or policies, please contact our office by calling** (847) 398-0400**.

Arlington Pediatrics, Ltd. is located at:\
 3325 N. Arlington Heights Road, Suite 100A\
 Arlington Heights, Illinois 60004