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Doctors' Pediatric - Wilton & Ridgefield Pediatrician Offices

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Forms & Policies

18 & Over – HIPAA Release and Consent Form

Record Release Form

Why am I getting a copay on a physical?

Telemedicine Informed Consent

Med Authorization Forms – PDF

 

Cancellation and No Show Policy:

All no-shows and cancellations of physical exams within 24 hours of the appointment will be charged $50.00.

Do you need a prescription refill?

Effective immediately, prescription refills will require 3 days’ notice.  However, most refills will be handled by the next business day. Prescriptions for ADD/ADHD medication or any other controlled substance will only be refilled Monday thru Friday.  Thank you in advance for your understanding.

*effective August 2, 2021

Do you need Camp, Sport, or Blue school forms?

Forms will be available for pick up on the third business day after drop off. There is a $10.00 fee per form, payable at the time of pick up. As always, we will provide a CT State Blue Form at the time of your child’s physical FREE OF CHARGE, there is a $10 fee if additional copies are needed. Thank you for your anticipated cooperation in this matter.

*effective 4/02/2019

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Office Locations

Wilton: 55 Danbury Road Wilton, CT 06897 (map) 203.762.3363

Ridgefield: 10 South Street Ste 206 Ridgefield, CT 06877 (map) 203.431.3363

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