PEDIATRIC ASSOCIATES

OF WATERTOWN

Thrive

The following are the forms needed if you are establishing with our office. Please fill these out and return them to our office. Please remember to bring your insurance card and ID to every appointment! Thank You!

Medical Records Release: Ages Birth-12 years and Patients over 18 years

Medical Records Release: Ages 12-17 years only

Minor Consent to Release Medical Information to Parents/Guardian (Patients 12-17 years of age)

Patient Information Sheet

Patient Information Sheet-18 years and older

Pediatric Associates Vaccine Policy

Initial History Questionnaire

Notice of Privacy Practices

Office Policy and Procedure Agreement

Non-Covered Services Waiver

Parent/Guardian Consent Form

Below are some helpful links to sites and parent education that we love!

My Super Tracker

Choose My Plate

Zero to Three

Shot by shot

HealthyChildren

CDC

Kids' Symptom Checker

KIDS.gov

Please also take a look at the helpful handouts we have linked below!

Ibuprofen & Tylenol Dosing Chart

Vaccine Information

2020 Recommended Vaccinations for Infants and Children (birth though 6 years)

2020 Recommended Vaccinations for Children (7-18 Years Old)

Sliding Fee Scale

No patient will be denied access to services due to inability to pay and a sliding fee schedule is available.

Sliding Fee Scale Notice

Sliding Fee Scale Application