The following forms are available for downloading:

• Consent to Share Protected Health Information
  Consent to Share Protected Health Information Form
• Medical Record Release – Incoming
  To authorize transfer of your child’s health records to Merrimack Valley Pediatrics
• Medical Record Release – Outgoing
  To authorize transfer of your child’s health record to another medical provider
• Consent to Treatment
  Permission for someone other than parent or guardian to accompany child for appointment
• Immunization Statement
  Immunizations protect your child against very serious infectious diseases
• Immunization Well Child Exam Schedule