A toddler sitting on a tree stump in a forest, wearing a striped shirt, black jeans, and black boots.

HIPAA Authorization of Release Form

Please fill out this form if you need to transfer medical records into or out of Unionville Pediatrics.

Young girl with long hair holding a small flower, wearing a pink headband and smiling while sitting on grass in a park.

State of Connecticut Health Assessment Record (birth-5)

For children ages birth to five, please use this form for any daycare or school-related requirements.

Person wearing glasses, a denim jacket, gray hoodie, and beanie, smiling against a blue wall.

State of Connecticut Health Assessment Record (5 +)

For children over five, please use this form for any school or camp-related requirements.