FORMS

Save Time Before Your Child's Pediatric Appointment

Due to the nature of our practice, we ask to complete many forms, including school forms, camp forms, and other types of forms. In order to expedite this process, we ask that you complete as much as you can of the form and include a stamped, self-addressed envelope, otherwise, the form will be filed in your child's chart and will be available for you to pick up at your convenience. We suggest that you call prior to coming into the office to verify that the form has been completed at 413-525-1870.

COVID-19 VACCINATION FORMS AND INFORMATION


You can find here the forms for your child's appointment. Please fill these out before you arrival for our nurses.

Medicine and Health Care Concept — East Longmeadow, MA — Pediatric Services of Springfield

Patient Forms -

 email to: medrecords@pediatricservices.org


Patient Information Packet

This packet explains our office policy, when you will need to make an appointment for your child, and what happens at each visit.

Download our Patient Information Packet

Authorization for Release of Medical Records
This form should be completed and sent to your child's previous physician for the release of medical records to be sent to us. It is important for us to have your child's previous medical records before your first appointment at our office.
Vanderbilt ADHD Diagnostic

Referrals

Please call the referral line at 413-525-1870 Ext 4 with the following information or send it electronically.

-patients name / DOB

-date of service

-reason for visit

-servicing provider's NPI



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