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Medical Home
Resources and links for healthy living and comprehensive care
Forms & Links
Need to fill out a form or find more resources? Start here.
Using Patient Portal
Keep track and make things easier!
Contact our Staff
Not sure what you need? We’re here to help.
Medical Home
Not sure where to start when looking for reliable medical information for your family? We’ve compiled many links to get you started:
Teen Health
Mental Health
Vaccine Information
Click here for resources about vaccines.
Nutrition & Exercise Resources
Click here for our list of resources.
Asthma Resources
Click here for our list of resources.
Evaluating Health-Related Sites
A vast amount of valuable health information is available on the Internet. We urge you to consider the source and quality of information found there. Read more.
Medically Complex Children
MA Commission for the Deaf & Hard of Hearing
Hospital Equipment Loan Program (HELP)
Mass Assistive Technology Program
Massachusetts Technology Assistance Resource Team (MASSTART)
The AT Exchange in New England
Augmentative Communication Program
The Family Center on Technology and Disability
Agencies & Programs
Department of Children & Families (DCF)
Refugee and Immigrant Health Program
Department of Developmental Services
Injury Prevention & Control Program
Bureau of Environmental Health
Bureau of Family Health & Nutrition
MA Tobacco Cessation & Prevention Program
Federation for Children with Special Needs in Massachusetts
Forms & Handouts
A NOTE ABOUT FORMS AND FEES:
Your child’s school form is provided at no cost. Please keep the original form. You may photocopy it as needed for additional activities such as camp and sports. This form is good for one year from your child’s last physical. Patients with online portal access can also access forms as needed.
If transferring to another physician a single copy of your complete medical record is provided at no cost. A signed medical records release authorization form must be received before forwarding a copy of your medical record.
Any additional copies of forms are subject to $0.50 per page for the first 100 pages and $0.25 for each additional page in excess of 100 pages.
There is a base fee of $15.00 for those records requested by any agency or attorney for the cost of labor, supplies and postage.
Please allow 5-7 business days for the completion of all forms and transfer of medical records.
General Forms
Release authorization from Middleboro Pediatrics
Your Child’s Next Physical
Please look at the list below and click on the age that your child will be at his/her next physical. Please print out the forms listed and complete them. Don’t forget to bring the completed forms with to the appointment.
NEWBORN - 1 YEAR
Click on the “+” for more information about your child’s next physical.
2-3 Weeks
No immunizations or lab work are needed at this visit.
We will be discussing nutrition, development, and safety issues plus any other concerns that you have.
6-8 Weeks
The following immunizations are usually given at this visit:
-
Vaxelis (combination DTaP, HIB, Hepatitis B and Polio vaccines)
-
Pneumococcal Conjugate (PCV15)
Due to a national shortage, Pentacel vaccine may not be available. If that occurs, we will substitute the individual components of the vaccine (DTaP, HIB, Polio) so your baby will continue to get the protection that he or she needs.
Please click on each of the above vaccine names to learn more about each vaccine.
Your provider will decide if any or all of the above immunizations are needed at this visit.
Additional immunizations might also be recommended.
No lab work is needed at this visit.
We will be discussing nutrition, development, and safety issues plus any other concerns that you have
4 Months
The following immunizations are usually given at this visit:
-
Vaxelis (combination DTaP, HIB, Hepatitis B and Polio vaccines)
-
Pneumococcal Conjugate (PCV15)
Due to a national shortage, Pentacel vaccine may not be available. If that occurs, we will substitute the individual components of the vaccine (DTaP, HIB, Polio) so your baby will continue to get the protection that he or she needs.
Please click on each of the above vaccine names to learn more about each vaccine.
Your provider will decide if any or all of the above immunizations are needed at this visit.
Additional immunizations might also be recommended.
No lab work is needed at this visit.
We will be discussing nutrition, development, and safety issues plus any other concerns that you have
6 Months
The following immunizations are usually given at this visit:
-
Vaxelis (combination DTaP, HIB, Hepatitis B and Polio vaccines)
-
Pneumococcal Conjugate (PCV15)
Due to a national shortage, Pentacel vaccine may not be available. If that occurs, we will substitute the individual components of the vaccine (DTaP, HIB, Polio) so your baby will continue to get the protection that he or she needs.
Please click on each of the above vaccine names to learn more about each vaccine.
Your provider will decide if any or all of the above immunizations are needed at this visit.
Additional immunizations might also be recommended.
If the lead screen form indicates a high risk for lead exposure, a lead level blood test will be done. Otherwise, no lab work will be needed at this visit.
We will be discussing nutrition, development, and safety issues plus any other concerns that you have.
9 Months
No routine immunizations are needed at this visit. If any immunizations were missed at any previous visit, catch-up immunizations might be given today.
A lead level and blood count will be done if not already done.
We will be discussing nutrition, development, and safety issues plus any other concerns that you have.
12 Months
A Nutritional Questionnaire needs to be completed.
Please click on the above link, print and complete the form, and bring them with you to the appointment.
The following immunizations are usually given at this visit
-
Pneumococcal (PCV20)
- Hepatitis A
Please click on each of the above vaccine names to learn more about each vaccine.
Your provider will decide if any or all of the above immunizations are needed at this visit.
Additional immunizations might also be recommended.
We will be discussing nutrition, development, and safety issues plus any other concerns that you have.
The office recommends to bring a personal item from home for comfort. This item could be a teddy bear, doll or blanket to help child with examination.
1 - 5 YEARS
Click on the “+” for more information about your child’s next physical.
15 Months
A Nutritional Questionnaire needs to be completed.
The following immunizations are usually given at this visit:
- MMR
- Varicella (Chicken Pox)
- Pentacel (combination DTaP, HIB, and Polio vaccines)
Your provider will decide if any or all of the above immunizations are needed at this visit.
Additional immunizations might also be recommended.
We will be discussing nutrition, development, and safety issues plus any other concerns that you have.
The office recommends to bring a personal item from home for comfort. This item could be a teddy bear, doll or blanket to help child with examination.
18 Months
A Nutritional Questionnaire needs to be completed.
Please click on the above link, print and complete the form, and bring them with you to the appointment.
We will be discussing nutrition, development, and safety issues plus any other concerns that you have.
The following immunizations are usually given at this visit
The office recommends to bring a personal item from home for comfort. This item could be a teddy bear, doll or blanket to help child with examination.
2 Years
A Nutritional Questionnaire needs to be completed.
Please click on the above link, print and complete the form, and bring them with you to the appointment.
The following immunizations are usually given at this visit:
- Hepatitis A ( if needed)
- CBC
- Lead screening
Your provider will decide if any or all of the above immunizations are needed at this visit.
Additional immunizations might also be recommended.
We will be discussing nutrition, development, and safety issues plus any other concerns that you have.
The office recommends to bring a personal item from home for comfort. This item could be a teddy bear, doll or blanket to help child with examination.
2.5 Years
A Nutritional Questionnaire needs to be completed.
Please click on the above link, print and complete the form, and bring them with you to the appointment.
No routine immunizations are needed at this visit. If any immunizations were missed at any previous visit, catch-up immunizations might be given today.
We will be discussing nutrition, development, and safety issues plus any other concerns that you have.
The office recommends to bring a personal item from home for comfort. This item could be a teddy bear, doll or blanket to help child with examination.
3 Years
A Nutritional Questionnaire needs to be completed.
Please click on the above link, print and complete the form, and bring them with you to the appointment.
The following tests are usually given at this visit:
- CBC
- Lead screening
We will be discussing nutrition, development, and safety issues plus any other concerns that you have.
The office recommends to bring a personal item from home for comfort. This item could be a teddy bear, doll or blanket to help child with examination.
4 Years
A Nutritional Questionnaire needs to be completed.
Please click on the above link, print and complete the form, and bring them with you to the appointment.
The following immunizations are usually given at this visit:
-
MMRV (Measles, Mumps, Rubella, and Varicella [Chicken Pox])
- Quadracel (Diphtheria, Tetanus, Acellular Pertussis [Whooping Cough], and Polio)
Please click on each of the above vaccine names to learn more about each vaccine.
Your provider will decide if any or all of the above immunizations are needed at this visit.
Additional immunizations might also be recommended.
A vision screen will be done.
We will be discussing nutrition, development, and safety issues plus any other concerns that you have.
5 Years
A Nutritional Questionnaire needs to be completed.
Please click on the above link, print and complete the form, and bring them with you to the appointment.
No routine immunizations are needed at this visit. If any immunizations were missed at any previous visit, catch-up immunizations might be given today.
A vision screen will be done.
Vision screening will not be necessary if your child wears glasses and sees an eye doctor.
A hearing test will be done.
We will be discussing nutrition, school, and safety issues plus any other concerns that you have.
6 - 11 YEARS
Click on the “+” for more information about your child’s next physical.
6 Years
A Nutritional Questionnaire needs to be completed.
Please click on the above link, print and complete the form, and bring them with you to the appointment.
No routine immunizations are needed at this visit. If any immunizations were missed at any previous visit, catch-up immunizations might be given today.
A vision screen will be done.
Vision screening will not be necessary if your child wears glasses and sees an eye doctor.
A hearing test will be done (if not done previously).
We will be discussing nutrition, school, and safety issues plus any other concerns that you have.
7 years
A Nutritional Questionnaire needs to be completed.
Please click on the above link, print and complete the form, and bring them with you to the appointment.
No routine immunizations are needed at this visit. If any immunizations were missed at any previous visit, catch-up immunizations might be given today.
A vision screen will be done.
Vision screening will not be necessary if your child wears glasses and sees an eye doctor.
A hearing test will be done.
We will be discussing nutrition, school, and safety issues plus any other concerns that you have.
8 Years
A Nutritional Questionnaire needs to be completed.
Please click on the above link, print and complete the form, and bring them with you to the appointment.
No routine immunizations are needed at this visit. If any immunizations were missed at any previous visit, catch-up immunizations might be given today.
A vision screen will be done.
Vision screening will not be necessary if your child wears glasses and sees an eye doctor.
A hearing test will be done.
We will be discussing nutrition, school, and safety issues plus any other concerns that you have.
9 Years
A Nutritional Questionnaire needs to be completed.
Please click on the above link, print and complete the form, and bring them with you to the appointment.
The following immunization is usually given at this visit:
-
HPV (Gardasil) vaccine (unless child has already received 2 doses)
Please click on the above vaccine name to learn more about the vaccine. You and your provider will decide if the above immunization will be given at this visit.
Additional immunizations might also be recommended.
A vision screen will be done.
Vision screening will not be necessary if your child wears glasses and sees an eye doctor.
A hearing test will be done.
We will be discussing nutrition, school, and safety issues plus any other concerns that you have.
10 Years
A Nutritional Questionnaire needs to be completed.
Please click on the above link, print and complete the form, and bring them with you to the appointment.
The following immunization is usually given at this visit:
-
HPV (Gardasil) vaccine (unless child has already received 2 doses)
Please click on the above vaccine name to learn more about the vaccine. You and your provider will decide if the above immunization will be given at this visit.
Additional immunizations might also be recommended.
A vision screen will be done.
Vision screening will not be necessary if your child wears glasses and sees an eye doctor.
A hearing test will be done.
We will be discussing nutrition, school, and safety issues plus any other concerns that you have.
11 Years
A Nutritional Questionnaire needs to be completed.
Please click on the above link, print and complete the form, and bring them with you to the appointment.
The following immunizations are usually given at this visit:
-
Tdap (Tetanus, diphtheria, acellular pertussis [whooping cough]) vaccine
- HPV (Gardasil) vaccine
Please click on each of the above vaccine names to learn more about each vaccine.
Your provider will decide if any or all of the above immunizations are needed at this visit.
Additional immunizations might also be recommended.
Your provider will decide if any lab work is needed.
Your provider will decide if a vision screen or hearing test is needed.
We will be discussing nutrition, school, and safety issues plus any other concerns that you have.
Female 12 - 18 YEARS
Click on the “+” for more information about your child’s next physical.
12 Years
A Nutritional Questionnaire needs to be completed.
An adolescent-health-questionnaire needs to be completed.
Please click on the above links, print and complete the forms, and bring them with you to the appointment. Preferably, your child should complete the adolescent questionnaire herself.
The following immunization is usually given at this visit:
-
HPV (Gardasil) vaccine (unless child has already received 2 doses)
Please click on the above vaccine name to learn more about the vaccine. You and your provider will decide if the above immunization will be given at this visit.
Additional immunizations might also be recommended.
If your child has started her menstrual periods, a blood count (CBC) will be done.
Your provider will decide if any additional labwork is needed.
Your provider will decide if a vision screen or hearing test is needed.
We will be discussing nutrition, school, and safety issues plus any other concerns that you have.
13 years
A Nutritional Questionnaire needs to be completed.
A TB RISK ASSESSMENT form needs to be completed.
An adolescent-health-questionnaire needs to be completed.
Please click on the above links, print and complete the forms, and bring them with you to the appointment. Preferably, your child should complete the adolescent questionnaire herself.
No routine immunizations are needed at this visit. If any immunizations were missed at any previous visit, catch-up immunizations might be given today.
If your child has started her menstrual periods, a blood count (CBC) will be done.
Your provider will decide if any additional labwork is needed.
Your provider will decide if a vision screen or hearing test is needed.
We will be discussing nutrition, school, and safety issues plus any other concerns that you have.
14 Years
A Nutritional Questionnaire needs to be completed.
An adolescent-health-questionnaire needs to be completed.
Please click on the above links, print and complete the forms, and bring them with you to the appointment. Preferably, your child should complete the adolescent questionnaire herself.
No routine immunizations are needed at this visit. If any immunizations were missed at any previous visit, catch-up immunizations might be given today.
If your child has started her menstrual periods, a blood count (CBC) will be done.
Your provider will decide if any additional labwork is needed.
Your provider will decide if a vision screen or hearing test is needed.
We will be discussing nutrition, school, and safety issues plus any other concerns that you have.
15 Years
A Nutritional Questionnaire needs to be completed.
An adolescent-health-questionnaire needs to be completed.
Please click on the above links, print and complete the forms, and bring them with you to the appointment. Preferably, your child should complete the adolescent questionnaire herself.
No routine immunizations are needed at this visit. If any immunizations were missed at any previous visit, catch-up immunizations might be given today.
A blood count (CBC) will be done.
Your provider will decide if any additional labwork is needed.
Your provider will decide if a vision screen or hearing test is needed.
We will be discussing nutrition, school, and safety issues plus any other concerns that you have.
16 Years
A Nutritional Questionnaire needs to be completed.
An adolescent-health-questionnaire needs to be completed.
Please click on the above links, print and complete the forms, and bring them with you to the appointment. A parent can complete the TB risk questionnaire. Preferably, your child should complete all the other questionnaires herself.
The following immunization is usually given at this visit:
- Meningococcal vaccine (2nd dose)
Please click on the above vaccine name to learn more about this vaccine. Most but not all health insurances cover the second dose of the meningococcal vaccine. Please check with your health insurance before the visit to verify that your health insurance covers this vaccine.
A blood count (CBC) will be done.
Your provider will decide if any additional labwork is needed.
Your provider will decide if a vision screen or hearing test is needed.
We will be discussing nutrition, school, and safety issues plus any other concerns that you have.
17 Years
A Nutritional Questionnaire needs to be completed.
An adolescent-health-questionnaire needs to be completed.
Please click on the above links, print and complete the forms, and bring them with you to the appointment. A parent can complete the TB risk questionnaire. Preferably, your child should complete all the other questionnaires herself.
A blood count (CBC) will be done.
Your provider will decide if any additional labwork is needed.
Your provider will decide if a vision screen or hearing test is needed.
We will be discussing nutrition, school, and safety issues plus any other concerns that you have.
18 Years
A Nutritional Questionnaire needs to be completed.
An adolescent-health-questionnaire needs to be completed.
Adolescent Forms Information: please read
Adolescent Release/Consent to Share form needs to be completed.
Mass State Proxy form needs to be completed.
Please click on the above links, print and complete the forms, and bring them with you to the appointment. A parent can complete the TB risk questionnaire. Preferably, your child should complete all the other questionnaires herself.
A blood count (CBC) will be done.
Your provider will decide if any additional labwork is needed.
Your provider will decide if a vision screen or hearing test is needed.
We will be discussing nutrition, school, and safety issues plus any other concerns that you have.
Male 12 - 18 YEARS
Click on the “+” for more information about your child’s next physical.
12 Years
A Nutritional Questionnaire needs to be completed.
An adolescent-health-questionnaire needs to be completed.
Please click on the above links, print and complete the forms, and bring them with you to the appointment. Preferably, your child should complete the adolescent questionnaire himself.
The following immunization is usually given at this visit:
-
HPV (Gardasil) vaccine (unless child has already received 2 doses)
Please click on the above vaccine name to learn more about the vaccine. You and your provider will decide if the above immunization will be given at this visit.
Additional immunizations might also be recommended.
Your provider will decide if any additional labwork is needed.
Your provider will decide if a vision screen or hearing test is needed.
We will be discussing nutrition, school, and safety issues plus any other concerns that you have.
13 years
A Nutritional Questionnaire needs to be completed.
An adolescent-health-questionnaire needs to be completed.
Please click on the above links, print and complete the forms, and bring them with you to the appointment. Preferably, your child should complete the adolescent questionnaire himself.
Your provider will decide if any additional labwork is needed.
Your provider will decide if a vision screen or hearing test is needed.
We will be discussing nutrition, school, and safety issues plus any other concerns that you have.
14 Years
A Nutritional Questionnaire needs to be completed.
An adolescent-health-questionnaire needs to be completed.
Please click on the above links, print and complete the forms, and bring them with you to the appointment. Preferably, your child should complete the adolescent questionnaire himself.
Your provider will decide if any additional labwork is needed.
Your provider will decide if a vision screen or hearing test is needed.
We will be discussing nutrition, school, and safety issues plus any other concerns that you have.
15 Years
A Nutritional Questionnaire needs to be completed.
An adolescent-health-questionnaire needs to be completed.
Please click on the above links, print and complete the forms, and bring them with you to the appointment. Preferably, your child should complete the adolescent questionnaire himself.
Your provider will decide if any additional labwork is needed.
Your provider will decide if a vision screen or hearing test is needed.
We will be discussing nutrition, school, and safety issues plus any other concerns that you have.
16 Years
A Nutritional Questionnaire needs to be completed.
An adolescent-health-questionnaire needs to be completed.
Please click on the above links, print and complete the forms, and bring them with you to the appointment. A parent can complete the TB risk questionnaire. Preferably, your child should complete all the other questionnaires himself.
The following immunization is usually given at this visit:
- Meningococcal vaccine (2nd dose)
Please click on the above vaccine name to learn more about this vaccine. Most but not all health insurances cover the second dose of the meningococcal vaccine. Please check with your health insurance before the visit to verify that your health insurance covers this vaccine.
Your provider will decide if any additional labwork is needed.
Your provider will decide if a vision screen or hearing test is needed.
We will be discussing nutrition, school, and safety issues plus any other concerns that you have.
17 Years
A Nutritional Questionnaire needs to be completed.
An adolescent-health-questionnaire needs to be completed.
Please click on the above links, print and complete the forms, and bring them with you to the appointment. A parent can complete the TB risk questionnaire. Preferably, your child should complete all the other questionnaires himself.
Your provider will decide if any additional labwork is needed.
Your provider will decide if a vision screen or hearing test is needed.
We will be discussing nutrition, school, and safety issues plus any other concerns that you have.
18 Years
A Nutritional Questionnaire needs to be completed.
An adolescent-health-questionnaire needs to be completed.
Adolescent Forms Information: please read
Adolescent Release/Consent to Share form needs to be completed.
Mass State Proxy form needs to be completed.
Please click on the above links, print and complete the forms, and bring them with you to the appointment. A parent can complete the TB risk questionnaire. Preferably, your child should complete all the other questionnaires himself.
Your provider will decide if any additional labwork is needed.
Your provider will decide if a vision screen or hearing test is needed.
We will be discussing nutrition, school, and safety issues plus any other concerns that you have.
19 + YEARS
Click on the “+” for more information about your child’s next physical.
Female 19 +
A Nutritional Questionnaire needs to be completed.
An adolescent-health-questionnaire needs to be completed.
Adolescent Forms Information: please read
Adolescent Release/Consent to Share form needs to be completed.
Mass State Proxy form needs to be completed.
Please click on the above links, print and complete the forms, and bring them with you to the appointment. A parent can complete the TB risk questionnaire. Preferably, your child should complete all the other questionnaires herself.
Your provider will decide if any additional labwork is needed.
Your provider will decide if a vision screen or hearing test is needed.
We will be discussing nutrition, school, and safety issues plus any other concerns that you have.
Male 19 +
A Nutritional Questionnaire needs to be completed.
An adolescent-health-questionnaire needs to be completed.
Adolescent Forms Information: please read
Adolescent Release/Consent to Share form needs to be completed.
Mass State Proxy form needs to be completed.
Please click on the above links, print and complete the forms, and bring them with you to the appointment. A parent can complete the TB risk questionnaire. Preferably, your child should complete all the other questionnaires himself.
Your provider will decide if any additional labwork is needed.
Your provider will decide if a vision screen or hearing test is needed.
We will be discussing nutrition, school, and safety issues plus any other concerns that you have.
Handouts
We hope these downloads provide useful information. Please speak with your caregiver about any questions or concerns.
These handouts are for informational purposes only and should not replace the advice or care of your child’s physician.
Handouts A-C
Acne – Benzoyl Peroxide
Acne – General
Acne – Tretinion 01
Acne – Tretinion 02
ADHD Sleep Problems
Allergic Rhinitis – Environmental
Allergic Rhinitis – General
Anaphylaxis
Ankle Sprain Rehabilitation
Ankle Sprain Treatment
Autism and Asperger’s Resources
Blocked Tear Duct
Books – Prepare Girls for Puberty
Books – Prepare Older Sibling for New Baby
Bronchiolitis
Candidial Diaper Dermatitis
Colic
Common Cold
Constipation: Fecal Impaction
Constipation: General
Cradle Cap
Croup
Handouts D-I
Decreasing Cholesterol
Dental Care
Diarrhea
Discipline: General Info
Discipline: Misbehaving
Discipline: Temper Tantrums
Disposal of Unused Medicines
Dry Skin
Eczema – Environmental Precautions
Eastern Equine Encephalitis – EEE
Fever
Fifth Disease
Growing Pains
Gun Safety
Hand, Foot, and Mouth Disease
Head Injury
Head Lice
High Fiber Diet
High Fiber Recipes
Insect Bites
Handouts L-Z
Lyme Disease
Marijuana
Migraines
MRSA
Newborn
Night Terrors and Sleepwalking
Nosebleed
Poison Ivy
Rehab Exercises for Ankle Sprain
Routine Pediatric Problems
Sleep-Bedtime-Refusal-in-Toddlers
Sleep: Helping Your Baby Sleep Through the Night
Sleep Preventing Problems
Stuttering
Sunburn
Swimmer’s Ear
VCUG
Vomiting
Walkers
Warts
Wet Wraps
Using our Patient Portal
- Access all of your family members with a single account. Now you only need to remember one ID and password for the whole family!
- You may print out school forms, immunization records and other physician letters at home. No more extra trips to pick up forms in person!
- Complete screening questionnaires online prior to your child’s physicals. It is faster and makes for less forms to fill out while at the office!
- Use HIPAA secure email with our office’s staff and doctors for non-urgent medical questions, billing, referral and scheduling concerns. Much better than “phone tag” when you are busy during the day!
- Request medication refills easily and with a few clicks online. You will get an emailed response when your prescription is processed and ready!
- Access and view the content of your child’s medical record (note: limited access for adolescents 13 -17 yrs due to state privacy regulations)
- Access and view lab results as soon as they come back (note: very limited access for adolescents 13-17 yrs due to state privacy regulations)
- Automatically have the same chart access and communication with any of your child’s Mass General Brigham system specialists. This includes all Mass General Brigham, Mass Eye and Ear, and Spaulding Rehabilitation services and facilities. Keep all of your child’s medical information and doctors together in one chart and communicate with the entire team at the same time for better coordination of care!
- Access your medical information whenever you need it and where you need it, either on your smartphone or your computer.
To enroll your child under 18 years of age in Patient Gateway, please contact our office at 508-947-0630 for assistance. Signing up is easy to do and only takes a few minutes! Ask about signing up whenever you are in the office as well.
For our patients age 18 years or older, you may enroll on your own at the following website: Mass General Brigham Patient Gateway – Choose a Signup Method
FORMS & POLICIES
HOURS & APPOINTMENTS
SPECIAL NOTE: HOURS MAY BE SUBJECT TO CHANGE
Mon: 8:30 am - 7:00 pm
Tues., Wed., Thurs.: 8:30 am - 7:00 pm
F: 8:30 am - 5:00 pm
Sat: temporarily closed on Saturdays
Sundays & Holidays: Urgent Care by Arrangement