Forms and Policies
Office Forms
Patient Registration Form
PDF · Click to download
Greenwich Pediatrics Welcome Packet
PDF · Click to download
Greenwich Pediatrics Annual Form Fee
PDF · Click to download
Records Transfer with HIPAA Authorization
PDF · Click to download
HIPAA Privacy Policy
PDF · Click to download
Authorization to Accompany Minor
PDF · Click to download
Authorization to Release Information to Family Members
PDF · Click to download
Greenwich Pediatrics Financial Policy
PDF · Click to download
School and Camp Forms
CT Preschool and Daycare Form
PDF · Click to download
CT Public School Form
PDF · Click to download
NY Preschool and Childcare Health Form
PDF · Click to download
NY Public School Physical Exam Form
PDF · Click to download
Sports Form
PDF · Click to download
Authorization for Medication to be Given by School and Camp Personnel
PDF · Click to download
Accepted Insurance Plans
We accept the following insurance plans:
AXA Assistance
Aetna
Ameriben Solutions
Assurant Health
BCBS-CT
BCBS-NY Empire
Cigna
Daniel H. Cook & Associates
GEHA
EMBLEMHEALTH
Global Care
HIP of NY
Hawaii Mainland Administrators
Health First Health Plans
Health Net of NE
Health Plan INC.
HealthLink-NCPPO
Healthcare Partners IPA
Healthspring
HealthyCT
Mohawk Valley Plan
Medica
Medicaid-RI
Medical Mutual of Ohio
Meritain Health
Multiplan
NGS Coresource
Nippon Life Ins Co of America
North Shore-LIJ CareConnect
Oxford
PHCS
PaySpan
Tricare East
Tufts
United Healthcare
United Healthcare - The Empire Plan
United Healthcare Community Plan
United Healthcare Student Resources
United Medical Resources
UnitedHealthOne
*Note: Greenwich Pediatrics does not participate in any "ObamaCare"/"exchange" plans