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133 Littleton Road, Westford, MA → 120 Boston Road, Suite 1, Groton, MA → 19 Pierce Avenue, Fitchburg, MA →
  • HOME
  • ABOUT
    • Mission and Values
    • Hours
    • Locations
    • Walk-In Care
  • WHO WE SERVE
    • Infants
    • Pediatrics
    • Adolescents
    • Athletes
  • SERVICES
    • Acne Management
    • ADHD Testing
    • Allergy Testing
    • Asthma Management
    • Concussion Evaluation
    • Developmental Screenings
    • Ear Piercing
    • Flu Clinic
    • Gynecological Care
    • Immunizations
    • Newborn Education
    • Nexplanon
    • Sleep Consultation
    • Vision Testing
    • Walk-In Care
  • STAFF
    • Pediatricians
    • Nurse Practitioners / Physician Assistants
    • Allergist / Immunologist
    • Pediatric Neurologist
  • EDUCATION
    • Vaccine Information
    • Expectant Parents
    • Postpartum Depression
    • Safety
    • Growth & Development
    • Illness/Injury
    • Nutrition
    • Adolescent Health
    • Sexuality
  • CONTACT
  • BLOG
    • In the News
    • Provider’s Blog
    • Seasonal Safety
  • MORE
    • Become a Patient
    • Appointment Request
    • New Babies
    • Join Our Team
    • Office Video Tours
    • Forms & Policies
    • Patient Portal
    • e-statements
    • Referral Request
    • Bill Pay
    • Useful Links
    • Patient Reviews
  • HOME
  • ABOUT
    • Mission and Values
    • Hours
    • Locations
    • Walk-In Care
  • WHO WE SERVE
    • Infants
    • Pediatrics
    • Adolescents
    • Athletes
  • SERVICES
    • Acne Management
    • ADHD Testing
    • Allergy Testing
    • Asthma Management
    • Concussion Evaluation
    • Developmental Screenings
    • Ear Piercing
    • Flu Clinic
    • Gynecological Care
    • Immunizations
    • Newborn Education
    • Nexplanon
    • Sleep Consultation
    • Vision Testing
    • Walk-In Care
  • STAFF
    • Pediatricians
    • Nurse Practitioners / Physician Assistants
    • Allergist / Immunologist
    • Pediatric Neurologist
  • EDUCATION
    • Vaccine Information
    • Expectant Parents
    • Postpartum Depression
    • Safety
    • Growth & Development
    • Illness/Injury
    • Nutrition
    • Adolescent Health
    • Sexuality
  • CONTACT
  • BLOG
    • In the News
    • Provider’s Blog
    • Seasonal Safety
  • MORE
    • Become a Patient
    • Appointment Request
    • New Babies
    • Join Our Team
    • Office Video Tours
    • Forms & Policies
    • Patient Portal
    • e-statements
    • Referral Request
    • Bill Pay
    • Useful Links
    • Patient Reviews

Forms & Policies

Patient Registration Forms (Online Versions)

Please select the Patient Registration form below based on the patient’s age.

Registration Forms submitted on-line will be processed within 24 business hours Monday-Friday.

New Patient Registration Form for under the age of 18 (online version)

New Patient Registration Form, ages 18 and over (online version)

Registration Form (Print Version)

The form may be printed at home and brought to your appointment.

Registration Form (print version)

Other Forms

Authorization to Use and Disclose PHI

Consent to See and Treat

Divorced Parents – Informed Consent

HIPAA ~ Acknowledgement Form Minors

HIPAA ~ Acknowledgement Form 18+

Privacy Information for Medical Records

You’re 18 now… What does HIPAA mean to you! – A guide to understanding the privacy of your medical records

Notice-of-Privacy-Practices

Policies

Policy regarding WELL EXAMS / ANNUAL PHYSICALS

Patient Rights and Responsibilities

Referrals Policy

Advance Beneficiary Notice (ABN)

Inclement Weather & Cancellation Policy

Practice Policy and Procedures

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