Welcome Letter, Registration, Medical Forms and Notices
Thank you for considering Norwell Pediatrics. If you would like to be a patient, please download our “New Patient Packet” registration forms to fill out, print, and sign. If you are unable you may come by the office for a hardcopy packet. You may fax us the packet (781-468-9158) or drop them by the office. You’ll also need to change your PCP with your insurance company and transfer your records. Once these steps are complete we can then schedule your first visit.
New Patient Packet
Fill out these forms before trying to schedule your first visit.
New patients should download the “New Patient Packet” of forms to fill out and sign before the first visit.
At your first visit we will additionally have you electronically sign The Financial Agreement, Assignment of Insurance Benefits, Mass HIway Authorization, and Acknowledgement of Receipt of Privacy Notice. Please read these ahead of time here. You cannot sign these four items ahead of time and must do so at the first visit. In contrast, the “New Patient Packet” should be filled out ahead of time in order to schedule the first visit.
Please request to transfer your records to Norwell Pediatrics as soon as possible so that there is adequate time to review them. Records can be faxed to 781-468-9158 or mailed to Norwell Pediatrics, 164 Washington Street, Suite 102, Norwell, MA 02061.
View Individual Forms and Notices:
Only use these if you exactly which form you need. New patients need the full patient packet above and may not need some of the following items which are for special situations.
- Welcome Letter
- The Financial Agreement, Assignment of Insurance Benefits, Mass HIway Authorization, and Acknowledgement of Receipt of Privacy Notice (must be signed electronically at first visit)
- New Patient Forms
- Registration
- Medical History
- Spruce Texting Agreement
- Norwell Pediatrics Financial Policy
- Medical Release Forms
- Medical Records Transfer INTO Norwell Pediatrics
- Medical Records Transfer OUT OF Norwell Pediatrics
- Authorization Forms
- 18+ Year Old Parent Authorization Form
- Notices
- Notice of Privacy Practices
- Notice For Divorced and Separated Parents
- Behavioral Health (only to be completed at request of provider)
- Behavioral Health Intake Form (must be filled out prior to scheduling with Anne Marie)
- Behavioral Health Policy (must be signed in order to be seen by Anne Marie)
- ADHD Initial Evaluation Questionnaire
- ADHD Follow-up Questionnaire
1. Welcome Letter:
“It is important to keep your child well hydrated with frequent sips of liquids throughout the course of a fever. Infant’s wet diapers should be monitored, since with dehydration the urine output decreases. Any signs of dehydration should be discussed with our team at Norwell Pediatrics.”
– Dr. Natalya Davis, Norwell Pediatrics
2. The Financial Agreement, Assignment of Insurance Benefits, Mass HIway Authorization, and Acknowledgement of Receipt of Privacy Notice:
3. New Patient Forms:
“Rashes are very common. Many are benign, requiring only some moisturizer or topical steroids. Some rashes, however, can be signs of something more going on. Often we will need to see the rash to tell the difference.”
– Dr. Natalya Davis, Norwell Pediatrics
Registration Form
“Vomiting is typically a symptom of benign viral infection, especially if followed by diarrhea. However this still can be concerning if it leads to dehydration. Moreover, several other less benign illnesses can present with vomiting. Sometimes an evaluation is necessary.”
– Dr. Natalya Davis, Norwell Pediatrics
Medical History
“Allergies come in all varieties. Seasonal or environmental allergies, with sneezing, runny nose, and itchy eyes, are typically benign and can be treated with over the counter medications. We would be happy to see your child to rule out mimics of common allergies. Other allergies can include food or topical exposures which can be more concerning and should prompt a visit.”
– Dr. Natalya Davis, Norwell Pediatrics
Spruce Texting Agreement
“While mild cough can be associated with common colds, it is sometimes a sign of a more serious lower respiratory involvement. If your child has any trouble breathing or noisy breathing, has a high fever, has been coughing for longer than 3 days, or has any other concerning symptoms, we should evaluate them. We are happy to evaluate your child with any concerns.”
– Dr. Natalya Davis, Norwell Pediatrics
“A sore throat is often caused by a virus, especially if other symptoms of a cold are present such as a runny nose or cough. In this case we do not recommend any antibiotics as they are not helpful and can in fact be harmful. A sore throat can be quite painful, so we often recommend treating the pain with over the counter analgesics such as Tylenol (acetaminophen) or Motrin/Advil (ibuprofen) or sucking on ice or popsicles. Also some more serious infections, such as Strep throat, can be the cause of a sore throat, especially if associated with a fever. In that case antibiotics would be necessary to treat the bacterial infection. If you are unsure, please call our office so we can evaluate your child.”
– Dr. Natalya Davis, Norwell Pediatrics
Norwell Pediatrics Financial Policy
“Getting adequate sleep is extremely important for growing children. This is often under-recognized and not prioritized”
– Dr. Natalya Davis, Norwell Pediatrics
4. Medical Release Forms:
Medical Records Transfer INTO Norwell Pediatrics
Medical Records Transfer OUT OF Norwell Pediatrics
“Good dental care begins even before your baby has teeth, it is a good idea to wipe down your infants gums even before the first tooth erupts”
– Norwell Pediatrics
5. Authorization Forms
18+ Year Old Release of Information
6. Notices:
Notice of Privacy Practices
“We recommend the first dental visit soon after your baby’s first birthday, especially if they have 6 or more teeth. Tooth eruption can occur on a highly variable schedule. We will monitor this at our well child visits, but should not be cause for concern.“
– Dr. Natalya Davis, Norwell Pediatrics
Notice For Divorced and Separated Parents
7. Behavioral Health
Behavioral Health Intake Form
(needed to see Anne Marie only)
Behavioral Health Policy
(needed to see Anne Marie only)
ADHD Initial Evaluation Questionnaire
ADHD Follow-up Questionnaire
