Post Road Pediatrics Forms
If you are 18 years of age of older, we need your written permission to communicate with your parents. Please use this form to indicate whether or not Post Road Pediatrics has your permission to do so.
If you are 18 years of age or older, you are able to give your parents access to your MyChart portal by completing this form.
If you would like for us to communicate with another medical or behavioral health provider, school staff, or anyone else involved in your child's care, please complete the medical release form.
If you are requesting copies of your medical record for transferring out of our practice, or for your own record, or to provide to another physician/provider, please complete a record transfer form. If psychotherapy notes are being requested, please also fill out the psychotherapy record release form
If you would like someone other than a parent/legal guardian to bring your child to medical appointments, please complete the alternate care giver form
Please bring this completed packet to your first visit with our psychologist.