160 Robbins Street

Waterbury, CT 06708

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One Pomperaug Office Park

Southbury, CT 06488

Phone (203) 755-2999

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Fax (203) 755-6782

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    Pediatric Associates of Conn., P.C

    160 Robbins Street

    Waterbury, CT 06708

                                                     

                                                      Photo credit by: Simply Pause Photography

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    Please complete the following before your visit:

    Patient Forms

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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.