Patient Forms

When you arrive for your first visit at our office, we will have you fill out the following forms:

If you would like, you can print these forms and fill them out prior to your first visit.

Please bring copies of your child’s medical records and immunization records to your first visit. If you do not have copies of your child’s medical records, you can fill out the Authorization for Release of Medical Information form and fax it to your child’s previous physician, so that they can send us your child’s medical records.

If your child is less than 12 years old, we ask that you fill out surveys prior to each well child appointment .  These are available through our Patient Portal.  

If your child is 12 years old or older, he/she will need to fill out a Teen Questionnaire with each physical. This questionnaire will be made available through the Patient Portal and can also be filled out prior to your teen’s physical.

Office Policies


  • We recommend routine well child visits at 5 days, 2 weeks, 1 month, 2 months, 4 months, 6 months, 9 months, 12 months, 15 months, 18 months, 2 years, 2 1/2  years, and yearly after 3 years. We also see children for acute illnesses and consultations about long-standing issues. Please call our office to schedule appointments.
  • Patients are seen in our office by appointment only. If your child is acutely ill or has an urgent injury, he or she can usually be seen the same day. Appointments for less urgent visits will be made based on availability.
  • Appointments for well child exams must be made in advance, as we have a limited number of slots available for these exams each day. It is a good idea to call well in advance for these appointments in order to get a time and day convenient for you.
  • Our phones are open for making appointments from 8:30 am to 12:30 pm and from 1:30 pm to 5:00 pm. We urge you to call for an appointment as early in the day as possible. To schedule an appointment, call our office at (650) 574-2774.
  • We do not offer walk-in appointments. Please arrive a few minutes before your scheduled appointment time so that you can be checked in and your information can be updated before your child is seen.
  • Cancellations. As a courtesy to other patients, if you must cancel an appointment, please call us as soon as possible. Well child exams or consultations cancelled less than 24 hours before appointment time may result in a charge that is not covered by your insurance.


Please call your pharmacy with any refill requests. Your pharmacy will contact us for authorization of the refill. Please allow 24 hours for your request to be processed. Unless urgent, refill requests should not be left with the answering service after hours or on weekends. It is difficult for the on call physician to order medications if the patient’s chart is unavailable.


Immunizations protect your child against several serious, life-threatening diseases. Your child should have shots according to the following schedule. If your child’s shots are not up-to-date, call your health care provider’s office for an appointment.

View our Immunization Schedule for Infants and Children

Phone Advice During and After Hours

Our doctors provide phone advice to their patients throughout the business day by calling their patients back. We make every effort to return telephone calls as soon as possible. The doctors will help you determine whether your child needs to be seen immediately or whether you can treat your child at home. If there is an urgent matter, please let our receptionist know so that we may better assist you. For long-standing problems, such as bedwetting or behavioral problems, please schedule an appointment for a thorough consultation.

Night and Weekend Calls

If this is an emergency, please call 911 or go to the nearest emergency room.

After business hours, the doctors’ answering service can be reached by calling our regular office number, 650-574-2774. The answering service can also be reached by calling 1-877-271-6520.

They will help you determine whether your child needs to be seen immediately, whether you can wait until the next morning, or whether you can treat your child at home. If your child needs to be seen after our office is closed, our answering service can direct you to the After Hour Pediatric Urgent Care Clinic or the Emergency Room. A pediatrician is always available on call.

After Hour Pediatrics Urgent Care Clinic
210 Baldwin Avenue, San Mateo, CA
(650) 579-6581

Peninsula Medical Center (Emergency Department)
1501 Trousdale Drive, Burlingame, CA
(650) 696-5446