We are excited that you have chosen Village Pediatrics for your child's medical care. Your comfort and convenience are our priority, and we strive to make every visit to our office a positive experience. To help you get acquainted with our office and first visit procedures, we have included helpful information on this page.

Our Mission

Our practice is working together to build life-long relationships between our staff and our patients by consistently providing our patients with compassion, excellence and value. To fulfill this mission, we are committed to:

• Improving the lives of the children we serve by providing quality care in a child-centered environment.
• Listening to our young patients and their families who we are privileged to serve.
• Guiding our patients along a path of optimal health and wellness.
• Continually pursuing excellence at all levels through continuing education.

Patient Forms

To expedite your first appointment, please arrive a few minutes early to complete registration forms so that we have all the necessary information to treat your child. You may also download and print the forms from this website, fill them out ahead of time, and bring them with you to the first appointment.

Administrative Forms

• New Patient Registration
• Release of Medical Information to Village Pediatrics (request records from prior provider so that we may continue care for the patient)
• Release of Medical Information from Village Pediatrics (request records from our office to new provider)
• Authorization for care 16 year old - Parent not attending appt (when someone other than parent brings patient to the appointment)
• Consent to treat minor child (Parent not attending appointment for patient umnder age 16)
• Happy 18th Birthday (letter with advice for new adults)
• 18 year old HIPAA Release & Authorization (This is Village Pediatrics HIPAA, not a general one)
• HIPAA Release Form

Well Child Visit Documents

• Two Week to One Month Well Child Check
• Two Month Well Child Check
• Four Month Well Child Check
• Six Month Well Child Check
• Nine Month Well Child Check
• Twelve Month Well Child Check
• Fifteen Month Well Child Check
• Eighteen Month Well Child Check
• M-CHAT Assessment (Autism Screening)
• PEDS Assessment (Global Developmental Screening)
• 5-yr Assessment

Other Handy Forms

• Immunization Action Coalition
• Preschool Children’s Medical Report
• Vanderbilt Initial- teacher
• Vanderbilt Initial- parent
• Vanderbilt FollowUp- teacher
• Vanderbilt FollowUp- parent
• Immunization Schedule

In order to view or print these forms, you will need Adobe Acrobat Reader installed. Click here to download it.

What to expect

A pleasant, comfortable first visit builds trust and helps put the child at ease during future visits. We want your child to enjoy getting to know our doctors and staff, so we work hard to establish this bond during every appointment to our office. During your initial appointment, we will explain everything in detail and answer any questions you may have.

We look forward to meeting you and your child and providing the quality, comprehensive medical care you expect and deserve.

Directions

IMPORTANT: Patient Portal

Due to HIPAA regulations that protect your personal information, ALL patient specific questions must be made via the patient portal.  Please use the patient portal option below for appointment requests or inquiries that include your child's name, DOB, or other specific patient ID info.   

THANK YOU!!