Contact

(401) 728-9208

(401) 305-7752

Address

126 Prospect St
Pawtucket,
Providence, RI-02860
USA

©2017 BY ENCOMPASS PEDIATRICS LLC.

Hours of Operation

Monday - Friday: 9 am - 5pm

Sunday: Closed

To save time for our patients, we have made available various forms on this page with an explanation as to what they are for. These forms can be downloaded, filled and brought to the office at the time of appointment. 

This form is to be used by patients who are new to the practice or for patients returning back to our practice for availing extraordinary care. Please make sure to fill out all the fields.

New Patient Registration Form

This form needs to be used if you would like us to request your medical records from another practice or release your medical records to someone else.

Medical Record Release form

This form is used to authorize the provider to receive payment for the medical service rendered.

This form needs to be brought in by every new patient.

Assignment of benefits Form

This form needs to be used if you plan to send in your child to routine visits with another responsible adult you know who can make medical decisions on your behalf in the event you are not reachable to make those decisions.

Medical Decisions for minors