At Worcester Pediatrics, our dedicated providers and staff are committed to providing our patients and families with the best, personalized pediatric services. This includes the resources you need to get the most out of our services to maintain your child’s optimal health and wellbeing.
To make your experience with our practice as convenient and accommodating as possible, we offer the following:
NEW PATIENT FORMS * (PDF)
Please complete the first 4 forms and bring to your first appointment. We must have your child/children’s medical records from their previous pediatrician before we can schedule a well-child exam.
- HIPAA Form*
- Consent To Treat Form*
- Family History*
- Release Of Information
- ADHD Parent Initial Form
- ADHD Teacher Initial Form
- GAD 7
- PH Q9
- Scared Child Form
- Scared Parent Form
- Adult ADHD Self-Report Scale
MEDICAL RECORD RELEASE FORM (PDF)
If you have decided to leave our practice, please use this form to request your child/children’s medical records from our practice. Please make sure the form is signed by a parent or guardian if the child is under 18 years of age. Any patient 19 or older MUST sign the form themselves. Please note there is a fee of $25 per record. Once we receive the form and fee, we will send the records out within 1 week.
Check your upcoming appointments, your financial statements or lab results, look at X-rays, send a message, and more.
At Worcester Pediatrics, we accept most insurance plans. We currently do not accept First Health, Fallon Medicaid, Humana, and ConnectiCare – just to name a few. Please call our office at (508) 363-9530 with any questions you may have.
- American Academy of Pediatrics (AAP) Parenting Website
- American Red Cross of Central & Western Massachusetts
- Food Allergy Research & Education (FARE)
- Vaccines for Your Children by the U.S. Centers for Disease Control and Prevention (CDC)