It takes a village to                    Raise a child

MEDICAL RELEASE FORM

If you are an existing patient and would like to request your medical records please complete the

release of medical records form. 

Once completed please email the form to: medrecords@pediatricservices.org

*Fees may apply*

REFERRALS

Please call the referral line at 413-525-1870 Ext 4 and leave a detailed message with the following information:

-patients name / DOB

-date of service

-reason for visit

-servicing provider's NPI

SCHOOL AND CAMP FORMS

Need school or camp forms completed? Drop a copy off at one our offices or email the form(s) to triage@pediatricservices.org

Please allow 2 weeks for forms to be completed, we appreciate your patience. We will contact you once your forms are ready. Please ensure the parent/child portion of the forms are completed prior to dropping forms off or emailing. 

Pediatric Services is currently accepting newborns to our practice. 

Expecting!!! Pediatric Services of Springfield is here for you and your growing family. Please contact our office for information about our practice.

After delivery, please contact our office 413-525-1870 to establish care and schedule your newborns first appointment with one of our pediatric providers. 

NEW/TRANSFER PATIENTS

new/transfer patient  information form

Once completed, please email the form to: medrecords@pediatricservices.org

MEDICAL RECORD RELEASE

If you are an existing patient and would like to request your medical records please complete the

release of medical record form. 

Once completed, please email the form to: medrecords@pediatricservices.org

We will contact your once completed request forms are received to collect applicable fees and complete your request.  *Fees may apply*

For specific questions please contact our medical records department 413-596-6886 ext. 204.