Pediatric Health Care Associates Forms & Policies

Before your scheduled appointment, quickly and conveniently access patient forms on MyChart. If you haven't signed up for MyChart, please call our office at 978-535-1110 and use option 8.

Please bring your completed forms with you to our office at the time of your visit.

To view the forms listed below, you will need Adobe Reader. You may download Adobe Reader for free at www.adobe.com.

• Authorize to Release or Obtain Medical Records: Please use this form when transferring in or out of the practice OR when you need a copy of your records for personal or legal use.
• Authorize Disclosure of Confidential Information Form: Please use this form to authorize us to speak with people who are not a legal guardian (Example: parents of patients that are 18 years of age or older, schools, therapists).
• A Letter to Parents of Teens

En Español

• Autorización Para Divulgar Información De Salud Protegida

If you'll be traveling within the next two weeks please contact the office at 978-535-1110, option #2 and speak with one of our nurses. This will ensure we are able to evaluate your request and give you the appropriate recommendations as soon as possible.

• Request for Travel Medicine Services

Download Office Policies

• Notice of Privacy Policy
• Vaccine Refusal/Deferment Policy