Forms and Policies

Before your first visit, please complete the new patient packet and vaccine consent. This will help speed up your check-in process before your first visit.

NOTE: Please read our vaccine policy carefully. At Parkwood Pediatrics, we strive to provide the best care possible, and we feel that includes preventing serious disease with vaccines. If you have questions regarding vaccines that you would like to discuss with your child’s doctor, please do not hesitate to ask! We are always ready and willing to have a discussion and answer any concerns you may have.

If you do not wish to vaccinate your children after discussing all questions with your physician, we will kindly ask that you find a practice which better aligns with your values.

For thorough and valid vaccine information, please visit the website below:

Children’s Hospital of Philadelphia Vaccine Education Center

For all requests made on the portal, please allow 48 hours for medication refill (including all ADHD med requests) and form completion requests. Please allow 72 hours for all immunization record requests.

We kindly ask you do not call back to check on the status of your requests until AFTER the 48 hour or 72 hour time period.

Thank you!

Open 356 Days a Year

Mon-Fri: 8:00 am - 5:00 pm

Sat-Sun & Holidays: 9:00 am - 12:00 pm
for established patients

  • Phones open at 8am for scheduling

New Patients

New Patient Packet

Authorization to Treat Minor Patients

Policies & Consent Forms

Established Patient Signature Form

Parkwood Pediatric Group Financial Policy

Authorization to Keep Credit Card on File
COVID-19 Vaccination Consent Form
Influenza Vaccine Consent Form
Fluoride Varnish Consent Form
Vaccine Policy Statement & Consent
Authorization for Release of Information
Vanderbilt Assessment Consent
Vanderbilt Teacher Form

Patient Authorization for Personal Representative