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Policies & Forms

Learn about the policies that help us provide you with the very best of care.

A group of adolescents hiking in the woods

Policies & Forms

Learn about the policies that help us provide you with the very best of care.

Appointment Policies Forms & Downloads Vaccination Policy Specialist Referrals

Appointment Policies

Scheduling an Appointment

Essex Pediatrics is available for you 365 days a year! (We are closed for appointments on Thanksgiving and Christmas, but a provider is still available through our answering service.) Urgent visits are available during the evenings and on weekends.

We do require an appointment for your child to be seen. Please call us during office hours to schedule a visit. When scheduling a sick visit, please call early in the day and ask to speak with a nurse. This will help us to see your child during office hours and before pharmacies close.

For urgent matters that cannot wait until business hours, call our office to be connected to our answering service. They will relay your message to the provider on call, who will call you back within 10-20 minutes.

Triage Nurses

During office hours, nurses are available by telephone to answer questions and offer advice. For questions that will not likely require an appointment, please call between 11 am and 4 pm when the telephone nurses have more time available to assist you.

For newborns, our nurses are happy to assist you with breastfeeding. Please call our office to schedule a time to meet with a nurse in the office.

Missed or Late Appointments

Missed appointments represent a cost to us and other patients who could have been seen during this time. Thank you for your understanding.

Cancellations are requested 24 hours prior to the appointment.
We reserve the right to charge for missed or late cancelled appointments.
Several missed appointments may result in dismissal from the practice.
If you are more than 15 minutes late, we may need to reschedule your appointment.

Minor Patients

For special custody arrangements or changes to current custody, please provide appropriate documentation, as we do not receive any information from the court.

Student Training

Our physicians and nurse practitioners volunteer their time participating in the education of student physicians and student nurse practitioners. When students are in the office, we will ask your permission to allow them to speak with you and examine your child. If you wish to be seen by your provider only, please tell the nurse.

Forms & Downloads

New Patient Forms

Please complete the forms below in preparation for your first visit.
New Family RegistrationComplete this form once for each family or household. You will need your insurance card(s).
New Patient RegistrationComplete this form once for each new patient in the family.

Release and Consent Forms

Patient Records

Assessments

Mental Health Provider Forms

Eliza BehrsingClinical Social Worker
Nicole BreslendLicensed Clinical Psychologist
Cath BurnsPsychologist
Cara CorneauPsychotherapist
Nicole Giard-JeterLCMHC
Nick HunterLicensed Psychologist - Master
Megan MayoCurrently Enrolled: Antioch Clinical Psychology Doctorate Program
Sarah McCrackenClinical Social Worker
Clara RiversClinical Social Worker
Jessica ScottRostered Psychotherapist
Sarah SoltsovRostered Psychotherapist, Specialization: Marriage and Family Therapist
Jenn SpagnuoloLCMHC, LADC
Ali WaltienLicensed Psychologist - Master
Gina WatsonClinical Social Worker
Kathy YanulavichClinical Social Worker
Shannon PorterMental Health Coordinator
Marley PowdenClinical Social Worker
Mental Health Interns

School Medication Forms

If your child will be taking medication at school, the school nurse will need written permission from you and the doctor. If you child has been diagnosed with asthma and will need an inhaler at school, the school nurse will need an Asthma Action Plan from your doctor.

Please allow one week for completion of any school form.

Vaccination Policy

Vaccines are extremely important to your child’s health, and to the health of our community. They are also one of safest and most evidence-based services we provide as a practice. We welcome your questions and partnership in this process.

Requirements for School Entry

Many vaccines are required for school entry. At your well child check, immunizations will be reviewed with your provider.

You have access to your child’s immunization record 24/7 through your patient portal.

Vaccination Resources

Vaccination Information StatementsThese fact sheets from the CDC include helpful information about more than 25 vaccines.
Vaccine Safety: The Facts
Recommended Immunization Schedules
Immunization Action Coalition
Vaccine Education Center

Specialist & Emergency Referrals

Many managed care insurance companies require prior authorization for specialty care and emergency room visits. Whenever possible, call our office for authorization before these visits to ensure your insurance company provides the payment outlined in your plan.

Mental Health Care Referrals

Essex Pediatrics will coordinate referrals for their patients to the mental health group. If your child is struggling with symptoms of mental illness please make an appointment with your Essex Pediatrics provider. After that appointment, our mental health coordinator will reach out to talk more about the process. Your child will be matched with a therapist based on their age, concerns, and insurance. We do often have a waitlist for individual counseling, but run regular therapy groups for a variety of needs that do not have a waitlist.

Office Hours & Urgent Visits

A provider is on call 24/7 for urgent questions or concerns. If your child’s illness or injury is life-threatening, call 911.

Office phones open at 9:00 am, 7 days a week except for Christmas and Thanksgiving. This includes routine questions, same day scheduling, refills, and other services.

Standard office visits are scheduled Monday-Friday from 9:00 am to 5:00 pm, but a provider will be in the office every day for additional hours.

For urgent visits, appointments may be scheduled after 5:00 pm Monday-Friday, and after 9:00 am on Saturday and Sunday. The office will close at different times based on patient volume, call early to make sure you get an appointment.

We require an appointment for your child to be seen. To schedule a sick visit, please call early in the day and ask to speak with a nurse. This will help us to see your child during office hours and before pharmacies close.