908-233-7171908-233-7171

566 Westfield Avenue
Westfield, NJ 07090

Forms for Patients

At Pediatric Associates of Westfield, we believe your time is valuable. But at the same time, to give your family the excellent care you deserve, we need up to date vital information.

Rather than have you rush through the completion of these vital forms in our office, we have provided them here. Simply click on a document to open it, print it out and complete it in the comfort of your own home.

Take time to make sure everything is correct and complete. Then bring it with you when you come in for an appointment. Or you can fax the forms to 908-233-2255 and then call us at 908-233-7171 to make sure we have received it.

At Pediatric Associates of Westfield, we always have your best interests at heart.

We look forward to working with you to keep your children healthy.

Authorization to Release Healthcare Information

Authorization to Release Healthcare Information

Patient Registration Form

Patient Registration Form

Physical Evaluation Form

Physical Evaluation Form

Privacy Notice

Privacy Notice

Authorization to Release Healthcare Information

Universal Health Form

  • Services

    We will:
    • Track your child’s growth and development
    • Administer recommended immunizations
    • Promote healthy choices for illness and disease prevention
    • Provide pre-operative clearance
    • Offer a same-day appointment for sick children
    • Manage and coordinate care for chronic conditions
    • Offer Saturday appointments, both sick and well child care visits
    • Athletic exams
    • Provide free prenatal visits with Dr. Nicole Panza and Dr. Robert Panza
    • Have separate waiting areas for healthy and sick children
    • Provide Travel Medicine recommendations
  • Contact Information

    Pediatric Associates of Westfield
    566 Westfield Avenue
    Westfield, NJ 07090

    Phone: 908-233-7171908-233-7171
    Fax: 908-233-2255
    Email Us

    Clinic Hours:
    WALK-IN HOURS (No Appointment Necessary) 8:30 AM – 9:15 AM – Monday to Friday ONLY.
    Monday 8:30 AM – 5:00 PM
    Tuesday 8:30 AM – 6:00 PM
    Wednesday 8:30 AM – 5:00 PM
    Thursday 8:30 AM – 5:00 PM
    Friday 8:30 AM – 5:00 PM
    Saturday 9:00 AM – Noon
    Sunday for emergencies only.