Pedicorp provides these documents for your convenience. Printing and completing these documents before your child's appointments will help expedite the check-in/out process. Forms supplied by State of CT may change faster than we can publish to our website, it is always best to check with your school nurse to see which forms are required for your child's current/upcoming school year; as each school/school district has their our requirements.
- Patient Information Form
- Practice Policies and Written receipt of Practice Policies
- Notice of Privacy Practices(HIPPA)
- Written acknowledgement of receipt of notice of privacy practices(HIPPA)
- Prenatal questionnaire
- Request to release medical records TO Pedicorp
- Health history for sports participation must be completed prior to sports exam
- 'Blue' School Form State of CT
- 'Yellow' Pre-school Form State of CT
- State of CT Dept of Educations 2016-2017 school immunization requirements
- Sample of Medication Authorization Form (your school/camp may have their own version)
- Transferring out of Pedicorp
- Electric/Utility Policy