Forms & Policies

Elmwood Pediatric's Forms & Policies

Before your appointment with us, quickly and conveniently access patient forms from our practice. If you have questions about how to obtain records from another provider to give to us or how to send our records to another provider please call the Medical Records department at 585-244-9720.

Please print the forms, and fill them out. Bring them with you to your next appointment.

To view the forms listed below, you will need Adobe Reader. You may download Adobe Reader for free at Please bring your completed forms with you to our office at the time of your visit.

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Phone Policy

If you need to call us after regular office hours, your call will be answered first by a triage nurse, who will help determine whether your child needs to be seen emergently.   There is a pediatrician from the Elmwood Pediatric Group on call 24 hours a day for emergencies.  If you have questions about your child's health, we encourage you to call us during regular office hours whenever possible so that your family's records are available to the nurse and doctor as they discuss your concerns.

Clinton Crossings

Weekdays: Monday - Thursday, 8:00 a.m. - 5:30 p.m., Walk-ins 5:30 - 6:30 p.m.,
Friday - 8:00 a.m. - 4:30 p.m.
Saturday:  8:00 a.m. and 11:00 a.m.

Bushnell's Basin

Weekdays: 8:00 a.m. - 4:30 p.m.
Walk-ins: 8-9 a.m. Weekdays

About Appointments at Elmwood Pediatric Group

Each child will have a pediatrician and a Nurse Practitioner  who are identified as your primary care providers.  When you call for an appointment:

  • You can schedule a well child visit or revisit with your doctor or Nurse Practitioner.
  • Appointments are scheduled at Clinton Crossing Monday - Thursday between 8:00 a.m. and 5:00 p.m. and on Friday between 8:00 a.m. - 4:30 p.m. Bushnell's Basin appointments are scheduled Monday - Friday between 8:00 a.m. - 4:30 p.m.
  • Saturday appointments are scheduled at the Clinton Crossings office only.
  • Sick child visits can be scheduled the same day.  Please note - if your primary doctor is available, that's who you will see.  However, if your doctor is fully scheduled, is at the other office, or is not available that day, you will be seen by another care provider in the group.  Our physicians work in partnership with one another to provide continuous care to our patients, and they communicate regularly when they participate in the care of their partners' patients.
  • Walk-in hours are available at the Bushnell's Basin office from 8:00 to 9:00 a.m. Monday – Fridays or at the Clinton Crossings office from 5:30 - 6:30 pm Monday - Thursday.  These visits are limited to routine sick visits, such as earaches, sore throats and fevers and are on a “first come, first served” basis.   Chronic and recurrent problems cannot be adequately addressed in this format and still need to be scheduled at an appropriate time.
  • Saturday hours are available at the Clinton Crossings office, for routine well-child care and for sick visits.  When any child needs to be seen for a sick visit on Saturday we will be available at the Clinton Crossings office by appointment, 585.244.9720.
  • On Sundays and major Holidays, our doctors are available for urgently sick children.   Sick visits on these days can be scheduled by calling the Clinton Crossings office between 8:30 and 10:30 a.m.