Information for New Pediatric Patients

Information for New Pediatric Patients2017-11-16T10:55:42+00:00

New to our practice? Getting started is easy!

This simple 3 step process can help pediatric patients transfer to Pediatric Partners’ practice and start experiencing our wonderful care and service.

Transfer Your Records

Download this form to request a records transfer from your previous practice to Pediatric Partners before your first visit. That will allow us to get to know your child’s medical history and begin giving excellent care right away.

Authorization for the Release of Medical Records

Register as a Patient

All information regarding parents/guardians, address, dates of birth, contact phone numbers, insurance, insurance ID numbers, and co-payment information is required.

Registration includes a review of privacy practices and a signed acknowledgement of privacy practices (HIPPA). You can access these through the buttons below.

Parents and guardians of pediatric patients have options for registering with Pediatric Partners. They may:

  • Print the registration form in the link below and bring to the first visit or fax beforehand.
  • Complete the registration information at the time of the first visit. Please arrive 15 minutes prior to the scheduled appointment in order to register.
  • Begin the registration process by phone.

The registration process is not complete until signed forms are received and all insurance information is received.

New Patient Registration Form
Notice of Privacy Practices
Acknowledgement of Privacy Practices

Schedule an Appointment

Call us at (860) 286-0444 to schedule your child’s first appointment!

Please note: a parent or guardian must attend the child’s first visit. A form authorizing other caretakers to attend medical appointments may be completed by the parent or guardian at the time of the visit.

Please call our office if you have any questions or need assistance.