Forms & Policies

Practice Philosophy

Falmouth Pediatric Associates is dedicated to the care of children, adolescents and their families. Our care is designed to meet the physical and emotional health needs of all of our patients. This includes pediatric primary care geared towards health promotion, illness prevention, wellness, immunization and illness treatment. Our care is non-discriminatory and our office is handicapped-accessible.

Practice Hours

  • Monday- Friday 9 am- 5 pm.
  • The last appointment is generally scheduled at 4:30 pm.
  • On-call visits are available after hours on weekends when our office is on call for urgent care visits
  • We strive to see acute illnesses in a timely fashion.
  • Well visits are strongly recommended according to the recommended schedule, including annually for children aged 3 years and older.
  • Appointments are currently made by phone or in person. Text message reminders are sent for well appointments.

Specific Policies

  1. Adolescents aged 18 and above may give their own consent for medical care.
  2. By law, we must have the permission of adolescents 18 or older to discuss their care with a parent.
  3. Under age 18, adolescents generally require parental consent before receiving treatment. Exceptions to this include that testing and treatment related to pregnancy and sexual health, for which parents do not require parental consent.
  4. We consider the trust of even our youngest patients to be essential to good care. We will go to great lengths to be truthful to your child.
  5. We offer to continue providing care for your adolescent until his/her 22nd birthday. We recommend beginning the process of finding a new care provider 6 to 12 months prior to this. We are happy to assist with this process.
  6. Under certain circumstances, Falmouth Pediatric Associates may terminate our care relationship with you. This may include:
  7. a. Consistent failure to follow advice
  8. b. Consistent failure to pay bills
  9. c. Significant interaction difficulties, including abusive behavior towards any staff
  10. d. Forging of documents on our stationary
  11. If you need a copy of your/your child’s records, we ask 2 weeks notice and will charge a $10 copying fee.


Demographic sheet


Referral Slip


Permission to Request Records


Permission to Release Records


HIPPA Statement


Family History Sheet