Forms and Policies | Lexington Pediatrics

Downloadable forms

• Patient registration
• Medical record release form
• Financial policy
• Policy for children whose parents are separated or divorced
• Referrals and authorizations policy**

MyChart forms

• MyChart adult proxy access consent form
• MyChart billing
• MyChart registration

*Please submit completed forms by uploading to MyChart, faxing to 781-863-2007 or emailing to info@lexpeds.com*

**However, referral authorization policy forms can be emailed to mpescatore@lexpeds.com