Walden Pond Pediatrics Policies & Forms

Please review the following policies pertaining to financial, privacy, and requests for medical records:

• Adolescent Confidentiality Policy
• Demographic Updates
• Financial Policies
• Medical Records and Medical Forms
• No-Show and Late Policies
• HIPAA/Privacy Policy
• Chaperone Accompaniment and Authorization for Medical Visits Policy
• Waiting Room & Child Supervision Guidelines

Please send your child’s medical records to the practice (via fax) before your visit as a new patient. Contact our office with any questions related to this record transfer. Please print and complete the following forms before your first appointment:

• New Patient Intake
• Initial History Questionnaire
• VFC Patient Eligibility Screening

Additional Forms

• Records Release
• 18+ Consent