PATIENT Forms 

PATIENT REGISTRATION FORM


Click here. Please complete it fully, sign & date at bottom, then fax, mail or bring to our office. Once we receive this we can create a new patient electronic medical record in our system.  We also need records from your former pediatrician, and then we can schedule an appointment.


RECORD TRANSFER FORM


Here is a release form you can fill-out and give to your former pediatric practice. Click here. They may have their own form for you to use, but please advise we do not accept CDs or thumb drives.  Our fax number is 860-674-9442.


RECORD TRANSFER OUT FORM


If you need to request medical records to transfer to another practice, please click
here


CHADIS FORMS


These need to be completed prior to most well visits. Check out our well visit timeline and CHADIS pages - you will find links to age appropriate CHADIS forms there.


SCHOOL, CAMP AND SPORTS FORMS


Looking for information about School, Sport and Camp Forms? Please click here.