Forms

At the time of your child’s yearly physical exam you will receive a standard State of Connecticut school form. Please keep the original and make copies to attach to any additional forms you might need, such as for camp. If you need a form filled out on an “emergency” basis, or need extra forms, please let us know.

We appreciate your patience during the busy time of the year for forms – we want to make your “forms” experience as efficient and pleasant as possible!

Connecticut School Forms

Connecticut State Pre-School Form

Connecticut State Elementary, Middle, and High School Form

Willows Forms

2024-5 Injectable Flu Shot Administration Form

Willows Pediatrics Family Registration Form

Medication Administration Form

Authorization to Release Medical Records

Privacy Policy

Acknowledgement of Receipt of Privacy Policy

Welcome to Willows Pediatric Group, PC, a leading pediatric practice in Westport, CT. We offer a wide range of services for children of all ages, including well-child visits, vaccinations, and treatment of acute and chronic conditions. We are committed to providing high-quality, compassionate care to our patients and their families. Fairfield County, Norwalk Hospital. Virtual visits available. All of the physicians at Willows Pediatric Group are board certified by the American Board of Pediatrics and are Fellows of the American Academy of Pediatrics. Each doctor also holds an appointment at Norwalk Hospital. We enjoy working together, and are dedicated to providing a true “medical home” for our patients and their families. We have three wonderful advanced practice providers: Jessica Gonzalez, PA-C, Sarah Halloran, PA-C, and Amanda Nederlof, APRN. All three are pediatric professionals with years of pediatric experience in Fairfield County. As Physician Assistants (PA) and Advance Practice Registered Nurses (APRN), they are skilled professionals, qualified by academic and practical experience to provide complete medical care for infants, children, and adolescents. They have undergone intensive education at major medical centers and are trained to perform physical exams, diagnose and treat acute and chronic illnesses, order and interpret tests, provide counseling for preventive health care, perform minor surgical procedure, and prescribe medications. They have a wealth of experience diagnosing and treating common and uncommon medical problems, responding to emergencies, and advising and communicating with families. The physicians at Willows, together with our PAs, and APRN work together to ensure that we have flexible scheduling and can be responsive to urgent care and after-hours needs. Nursing mothers often need help after they leave the hospital. We are pleased to have on staff a Board Certified Family Nurse Practitioner and International Board Certified Lactation Consultant, Laurie Rubel, APRN, IBCLC, who is available by phone or in our office to answer questions and offer support with breastfeeding.Laurie meets with parents throughout the breastfeeding journey to provide support and troubleshoot issues. Additional support for parents of infants between birth and three months can be found in our newborn support group led by Laurie, which is a forum for parents to ask questions, share helpful hints, and connect with other new parents. To see or speak with Laurie, please call our office.