Performance Pediatrics^®
Partnering with Families through Childhood Milestones

23 Aldrin Road, Plymouth, MA 02360
508-747-8277 • fax: 508-747-1147

Forms and Handouts

New Patient Forms
Registration
Financial Policy and Acknowledgment
Consent and Privacy Practices Acknowledgment
Notice of Privacy Practices

Miscellaneous Forms
Young Adult Confidentiality/Release
Proxy Permission
Record Request from Performance Pediatrics
Record Request from Past Provider
School Disclosure
Refusal to Vaccinate

Performance Pediatrics is a proud member of: