Logo for: Pediatric Associates of Connecticut

Patient Forms

New Patient Forms (We are not accepting new patients at this time)

New patients must provide their insurance card along with the following completed forms prior to the first visit.

Medical Records Release

If the records are to be mailed, be sure to identify to whom the records are being released, the purpose for the disclosure and allow 30 days to process your request. Per Connecticut law, we may charge you per page plus postage.