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Patient Forms

Established Patients Access

Through our patient portal, you can request appointments, request medication refills, and print forms. Your request will be responded to within 24-48 hours, during normal business hours. If you do not receive confirmation of your request within 48 hours, please contact our office by phone.

New Patient Information

Adolescent Transfer Policy

Please note for adolescents that are looking to transfer to our practice and are 14-years-old or older that Delaware Pediatrics only accepts the adolescent as a transfer if the adolescent has a sibling (s) under the age of 14-years-old, who also need to transfer. If you have any questions or require further information about our transfer policy, please call our office at (716) 884-0230.

Forms Information

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We recommend printing and filling out the forms below before your first appointment with our office. Please print and complete the Authorization of Release (Transfer in/Transfer out) form and return it to your previous doctor’s office. We do not request medical records on your behalf. It is your responsibility to ensure your child’s records are transferred to our office in a timely manner. If your records are not received prior to your scheduled NEW patient appointment, your appointment maybe rescheduled.