"All Disease Begins in the Gut" - Hippocrates

Preferred Pediatrics Forms Policy

Physical forms are available through our office. We ask you to allow one week to complete the form but assure our families that we complete the form as soon as possible. We do have a $5.00 fee per form. We appreciate your cooperation with the fee. Thank you for your support


School Forms

There is a $5 fee for all school forms. We will no longer fax the Physical Forms to the school.

Please bring a self-addressed stamped envelope to your child's physical appointment. Preferred Pediatrics will mail the form back to you within two weeks.

Pick-up is also available but please allow the office 2 weeks for processing.

If your child attends camp it is our suggestion that you make a copy of the school form when you receive it.

 

New Patient Forms

Patient Demographics Form

Preferred Pediatrics Financial Policy

Notice of Privacy Practices

Acknowledgment of Receipt of Notice of Privacy Practices

 

Other Forms

Pre-Adoption Consultation Form

Religeous Exemption Certification

 


Office Hours


Monday, Tuesday, Thursday , & Friday

9:00 a.m. to 4:30 p.m.

Wednesday

9:00 a.m. to 1:00 p.m.

Contact Us


88 Noble Avenue
Suite 101
Milford, CT 06460

Phone: 203-874-2800
Fax: 203-874-0511