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Please complete the following before your visit:

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School Forms:

• Patient Registration Form

• Patient Registration Form 18+

• Family History Form

• Initial Patient History Form

• HIPPA Privacy Form

• Form Policy/Consent to Mail-Fax

• Record Release TO PAC

• Record Release FROM PAC

• HIppaNotice of Privacy Practices

• Health Assessment Record

• Early Childhood Assessment

• Medication Authorization Form

Pediatricians serving the Waterbury, Southbury, Naugatuck, Prospect, Wolcott, Watertown, Oxford, Woodbury and Thomaston                 areas.