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.
- Authorization to treat minor without parent or guardian present patients under age 18
- Patient Information Form to be filled out for new patients, annual exam visits, and when information changes
- Office and Financial Policies
- Notice of Privacy Practices(HIPPA)
- Acknowledgement of HIPPA, office and financial policies
- Sample of Medication Authorization Form (your school/camp may have their own version)
- "Blue" School Form State of CT
- 'Yellow' Pre-school Form State of CT
- Health history for sports participation must be completed prior to exam when child will be participating in sports
- Prenatal questionnaire
- Form for parents of child 9 months to fill out for well exam
- Form for parents of child ages 18 & 24 months to fill out for well exam
- Form for parents of child ages 4 to 10 years to fill out for well exam
- Electric/Utility Policy
- Request to release medical records TO Pedicorp
- Release of medical information to another provider FROM Pedicorp