Patient Forms

New Patient & Established Patient Registration

A New Registration Tool for Our Patients, Including the Ability to Register Before Your Visit!

Center for Pediatric Medicine is continuously looking for ways to improve our patients’ experiences. We’re therefore very excited to announce that we have just introduced new technology to improve our check-in process for our patients.

If you are a new patient and or transferring into CPM, you will be asked to provide the following information to our CPM team:

  1. Patients first & last name
  2. Contact number: Cell phone
  3. DOB
  4. Submit immunization records and previous medical records to the office

For existing and new patients, you will receive a text message 1-2 days before your appointment for pre-booked appointments or a text the day for a same day appointment. Simply click on the link, answer a few identifying questions, and you’ll then be able to complete your registration from home on any mobile device, tablet, or computer. We encourage you to take advantage of this easy, convenient Pre-Visit Check-in Process for your next visit!

You will be promoted to complete your check-in process electronically. If you are having trouble completing the registration before you arrive for an office visit, you will be given a “Phreesia-Pad (and or can be completed via the patients cellular device),” which is similar to an iPad or a tablet, to complete your registration electronically. Checking in via the “Phreesia-Pad (and or can be completed via the patients cellular device)” is quick and easy, as it guides you through a step-by-step registration process. Once you have entered your information for the first time, you will not be required to do so again. At your future visits, you will only need to verify the information that you’d previously entered to ensure that its current and to make any necessary edits.

Once you’ve submitted your information, you may also pay any balance or co-pay securely on the “Phreesia-Pad (and or can be completed via the patients cellular device)” . The Phreesia-Pad does not store any information on the pad. Rather, all entered information transfers electronically to your chart in our secure Electronic Health Record (EHR).

The registration is featured in the following languages: English, Spanish & Portuguese

You are able to complete the following items below before you come into the office:


  1. Confirm and or cancel your appointment via text message.
           a. Reminder of your appointment date, time, location & provider.
  2. You will be asked to check- in when you arrive at our facilities (Text “Here” to a text you will receive the same day as your appointment).
           a. This will notify the medical receptionist that you have arrived. A nurse will text you when you can come into the office.
  3. Complete any pre-screenings (COVID-19 Questionnaires)
  4. Patient and Family Registration | Demographics ( Verify who you are)
  5. Update your insurance information
  6. Clinical Screening Questionnaires (Based on the type of appointment- typically at the patients wellness visit. Completed forms prior to the visit will reduce the amount of time you need to spend in the office).
  7. Review and sign all consent and financial forms
  8. Store Credit Card on-file (Optional)
  9. Make a payment (Pre, during an or post visit)

Patient Policies

Medical Records