Forms

HIPAA Authorization of Release Form

Please fill out this form if you need to transfer medical records into or out of Unionville Pediatrics.

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State of Connecticut Health Assessment Record (birth-5)

For children ages birth to five, please use this form for any daycare or school-related requirements.

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State of Connecticut Health Assessment Record (5 and older)

For children over five, please use this form for any school or camp-related requirements.

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