East End Pediatrics Serving Newborns, Children, and Adolescents

forms: simple & easy

Important information needed for your visit.

East End Pediatrics is committed to serving the health needs of our patients. For your convenience we have provided downloadable forms for you to print and complete prior to visiting our office. Also, it is very important to bring your Insurance Card, Copay, and a Photo ID. All "new" patients should include Shot Records and arrive at least 15 minutes early. Your family deserves the best health care. We look forward to providing you exceptional service.

New Patient Forms

If you are visiting us for the first time, to make your visit to our practice more efficient and convenient, we have provided downloadable forms for you to print and complete prior to visiting our office. Please take a moment to complete the following forms (Patient Health History, Patient Registration, Insurance Information). We appreciate your cooperation and look forward to seeing you soon.

Additional Forms

Medical Release - To EEP

In an effort to make your transfer to East End Pediatrics a simple process, we have provided a downloadable form for you to print and complete prior to visiting our office.

Medical Release - From EEP

In an effort to make your transfer from East End Pediatrics a seamless process, we have provided a downloadable form for you to print and complete prior to leaving our office.

Additional Information

  • We accept all major insurance and Medicaid.
  • If you are over 15 minutes late, an appointment reschedule will be needed.
  • If your child is sick and needs to be seen immediately, call between 9:00am and 10:00am.
  • All vaccination appointments can be made a month in advance.