Riley Pediatric Surgery
Pediatric Outpatient Center
4935 W Arlington Rd, Suite A
Bloomington, IN 47404
Reopens on Tuesday 1:00 PM
*Location also offers Lab
Free Surface Parking
Free surface parking is available outside the building.
Doctors At This Location
Program Forms & Resources
The Pediatric Surgery - Riley Physicians Pediatrics at Riley at IU Health provides the following forms for parents, healthcare providers and personnel. We have also curated relevant resources from other websites and provided links with brief descriptions of the information that is available.
Please complete for the first visit.
Authorization to Release Medical Records
Complete this form when you’d like for medical records to be released to another entity.
You will be asked to review and sign this consent to receive care from our physicians and staff.
Complete this form to allow family and friends to receive information regarding your health.
What to Bring
- Your child’s current insurance information
- Form of identification
- List of all medications your child is currently taking, including how many times per day and the dose (be sure to include both prescription and over-the-counter medications)
- List of questions or concerns for your child’s doctor
- Medical records (e.g. X-rays, lab test results, etc.)—your referring physician may have already sent these records, so be sure to ask your doctor before your child’s visit with us
- Form of payment for any deductible and/or co-insurance required by your insurance plan
Programs & Departments
We provide multispecialty care for a number of conditions. Below are links to our related departments.