Resources
Patient Forms
Park Street Pediatrics
MON – FRI • 9am – 6pm
SAT • 9am – 2pm
SUNDAY – ON CALL
Forms & Policies
You’ll find almost every medical and office form you’ll need here. Most are available in PDF format to help you easily navigate through them. You may email them directly or fax them back to us at your convenience. Alternatively, you can print them out, send them through snail mail, or bring them into the office in person and keep a copy for your records as well.
We have made it a little easier by providing these forms online so that you may fill them out in the comfort and convenience of your home.
Office & Financial Information
Patient Information
We love to hear from you. Your comments and suggestions on what we can do better to help you are always welcome!
Authorization Forms
(Request records FROM our office)
(Request records TO our office)
School & Sports Forms
- Connecticut law requires that licensed daycare providers and schools maintain current medical information on all children attending their facility. These are typically known as state blue forms.
- The Connecticut State Health Assessment Record is now inclusive for sports participation. If your child’s school requires a different form, please make sure you have the most current form to provide to our office for completion.
- Should you wish any forms or paperwork, such as school, sports or medication forms, to be competed and mailed back to you, please provide our office with a stamped self-addressed envelope.
Forms
Camps, sports clubs and school teams may require certain paperwork to be completed prior to your child’s participation. Please be aware that we require two business days to complete all forms of this type.
Also check the form carefully to determine the requirement for the child’s last physical exam. Many of the schools sports teams require that the child’s physical exam be done within a specific period, which may be within the past twelve months. If your child does not meet the specific form requirements, you will need to make an appointment to complete all necessary screenings or vaccinations prior to our completing the form.
Pre-Visit Questionnaire Forms
- If you are expecting, or have a newborn, please arrive about 15 minutes early to fill in our questionnaire before your first appointment.
History
If you are new to our practice or if you have not completed this form for our practice in the past, please complete this Family Medical History Questionnaire and bring it to your next appointment so that we may update our records.
