Patient Center

Patient Forms

ELM Pediatrics has made our forms available online for your convenience.

Please complete these forms before your child's appointment.


ELM Pediatrics accepts a variety of insurance plans.

  • Absolute Total Care
  • Aetna
  • Beechstreet
  • Blue Choice
  • Blue Choice Medicaid
  • Blue Cross Blue Shield
  • Cigna
  • First Choice / Select Health
  • Healthy Connections
  • Humana
  • Medcost Multiplan / Private Health Care Systems
  • Medicare
  • Molina Healthcare
  • PAI
  • United Healthcare

If you don't see your plan listed, please contact our office. The managed care health insurance market changes rapidly, and specific coverage questions should be discussed directly with your insurance company or our knowledgeable staff.

Office Policies


We request that all patients schedule appointments prior to coming to the office so that we may properly dedicate enough time to address your concerns. We know that your time is valuable and we want to respect your time while giving you and all of our patients the best care possible. If you are no longer able to keep your appointment time, please call and notify us immediately.

Arriving Late

We understand that life happens, especially when children are involved! We recommend that you arrive 15 minutes prior to your scheduled appointment time. That way, once you arrive in our office, this gives you enough time to complete necessary paperwork, update insurance information (and squeeze in those last minute bathroom breaks that are bound to happen with little ones). In the event that you arrive more than 15 minutes after your scheduled appointment time, we may need to reschedule your appointment, however, we will do our best to accommodate you that same day.

Prescription Renewal

Prescriptions and refills for medications are issued weekdays during office hours, except in emergency situations. For a routine prescription refill, please contact your pharmacy, and, if necessary, the pharmacist will call our office. For a refill of chronic or controlled medications, we ask that you give the office ten days notice to allow your doctor an opportunity to review your child's health record. Always have prescription and pharmacy numbers on hand when requesting refills. Please let us know if the patient is allergic to any medications.

Medical Records Release

Your child's medical records are maintained with strict adherence to patient confidentiality laws. You may, with a written, signed request, obtain copies of your child's medical records. Whether the copy is for you or for another physician we will forward the records, a reasonable number of times, at no charge. We may require up to 30 days notice to prepare your records. If you are moving, we recommend you pick up your records and take them to your new physician.