Forms & Policies
Elmwood Pediatric’s Forms & Policies
Before your appointment, please print and fill out any of the necessary forms below.
If you have questions about how to obtain records from or send records to another provider, please call our Medical Records department at 585-244-9720.
To view the forms listed below, you will need Adobe Reader.
- Release of Record Form
- Notice of Privacy Practices
- Adult Patient Authorization
- Release of Records from Former Pediatrician
Pay your Bill Online
Phone Policy – After Hours
If you need to call us after regular office hours, your call will be answered first by a triage nurse, who will determine whether your child needs to be seen urgently and then will direct you to the appropriate facility (Urgent Care or the Emergency Department) if needed. The triage nurses will return your call as quickly as possible, although the wait time may be up to 1 hour during the busy winter months. If you have not heard back within one hour, please call our office again to let the answering service know. There is always a physician from our practice on-call and available by phone 24 hours a day if needed.
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.
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.
Weekdays: 8:00 a.m. – 4:30 p.m.
Walk-ins: 8-9 a.m. Weekdays
Scheduling an Appointment
Each child will have a pediatrician who is identified as your primary care provider and our goal is to always have you see that provider if possible. If your primary doctor is not available, you will be seen by another provider in our group. Our physicians and nurse practitioners work in partnership with one another to provide excellent care to all our patients.
- Appointments may be scheduled at Clinton Crossing on Monday – Thursday between 8:00 a.m. and 5:00 p.m. and on Friday between 8:00 a.m. – 4:30 p.m.
- Appointments may be scheduled at Bushnell’s Basin, Monday – Friday between 8:00 a.m. – 4:30 p.m..
- 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 at walk-ins and need to be scheduled during regular office hours.
- Saturday hours are available at the Clinton Crossings office by same-day appointment. Please call between 8am-11am if you have an ill child who needs to be seen.
- On Sundays and major Holidays, sick visits can be scheduled by calling the Clinton Crossings office between 8:30 and 10:30 a.m.