Forms


The following downloadable forms are available in PDF format for your convenience. We encourage you to print them off, complete them at your leisure in the privacy of your home, and bring them with you to your appointment. Please be assured that no information is being transmitted over the Internet; you are merely printing a blank form.



The following forms* are available through our Patient Portal only:

  • A Preschool/Daycare Form
  • A School Blue Form
  • Boys Scout Health Form
  • Brewster School Form
  • Pop Warner Form
  • School Sports Participation Form
  • WIC Form
  • Camp Form/Generic

*All school, sports, daycare and camp forms completed will be $10.
*If needed within 48 hours (2 business days or less M-F), the cost of the form will be $15.

Spring and summer are our busiest times; please give us sufficient time to complete your form.

EFFECTIVE June 13, 2016:
Payment MUST be received before any form is dropped off or completed by our forms department.

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Contact Us

We welcome your inquiries by mail, telephone, or fax:

Pediatric Associates of Western Connecticut, LLC
41 Germantown Road
Danbury, CT 06810-4087

Telephone: (203) 744-1680
Fax: (203) 792-6510

Our Location

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Hours of Operation

Our Regular Schedule

Pediatric Associates of Western Connecticut

Monday:

9am – 5pm

Urgent care hours 6pm – 9pm

Tuesday:

9am – 5pm

Urgent care hours 6pm – 9pm

Wednesday:

9am – 5pm

Urgent care hours 6pm – 9pm

Thursday:

9am – 5pm

Urgent care hours 6pm – 9pm

Friday:

9:00 am-5:00 pm

Saturday:

8:30 am – 12 noon - Urgent Care Hours (depending on patient volume)

Sunday:

8:30 am – 12 noon - Urgent Care Hours (depending on patient volume)