“The best way to keep children home is to make the home atmosphere pleasant - and let the air out of the tires.”
- Dorothy Parker

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STAMFORD OFFICE
203.323.1770
NEW CANAAN OFFICE
203.972.5232

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Patient
Information/
Demographics

Guarantor
Financial
Agreement &
Authorization
of Treatment

Consent to
Treat
FOR CAREGIVERS
OTHER THAN PARENTS

18 Year Old
Packet

Newborn
Evaluation
Hospital Stay

CT State
Health
Assessment
Form

HIPPA
Authorization
for Release
of Patient
RECORDS-COMPLETE

HIPPA
Authorization
for Release
of Patient
RECORDS-PARTIAL

Notice
of Privacy
Practices
ACKNOWLEDGEMENT OF RECEIPT

Generic
Camp
Form

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DOCUMENTS

Newborn
Discharge
Guidelines

Childhood
Vaccine
Schedule

Notice
of Privacy
Practices

Internist
Referrals

Gynecology
Referrals

ADHD Protocol:
Evaluation
Guidelines
Office
Management
Family History