1625 Avenue Of The Cities Moline, IL 61265

(309) 797-5437

Patient Forms

Thank you for choosing Pediatric Group Associates as your child's medical home.  Pediatric Group Associates specializes in the comprehensive medical care of children from birth to college.  Our physicians, nurse practitioners, and staff are committed to providing a caring, attentive, and open relationship with you and your children to keep them well and help them grow up healthy and happy.  Our goal is to help each child reach their highest potential.   We want to be lifelong partners in your child’s health.  As such we take time to talk with parents about their child’s needs and equip them with the knowledge necessary for promoting a lifetime of optimal health and wellness.

We consider it a great joy, privilege, and responsibility to care for children.  Thus, from preventative well child check-ups, to treatment of acute illnesses and ongoing management of chronic conditions, we strive to meet and exceed our families’ expectations while maintaining the highest standards of excellence in pediatric medicine.

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 appointment. Questions about which forms you need? Please call our office and our staff will assist you in preparing for your child's visit.


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Click here to download it.

Pediatric Group Associates


1625 Avenue Of The Cities,
Moline, IL 61265

Our Sick Clinic is currently open 8 am to 10:45 am Monday through Friday (this is NOT a walk-in clinic). 

We recommend using our self-scheduling link , appointment request link, or calling us before arriving at the office to reserve your time slot.

The sick clinic is for acute problems like rashes, insect bites, poison ivy, sunburn and ear pain.    We continue to take additional precautions to ensure the safety and health of our patients and staff through the use of our mobile registration and gathering information in advance of your appointment. 

Thank you for your continued patience and support as we strive to meet the ongoing needs of our community in the safest possible manner.

Our Moline office is open from 8 am to 1 pm and 2 pm to 5 pm Monday through Friday.  We have limited Saturday availability for acute sick symptoms only through our Facebook self-scheduling link which will be posted each Friday evening by 7 pm CST.   We do not have regular office hours on Sunday, however there is a provider on-call in case of emergencies.

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Please do not submit any Protected Health Information (PHI).