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Bay Street Pediatrics

Caring For Your Children From Birth to College Since 1978 - Westport, CT

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    • Why Choose Bay Street Pediatrics?
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    • Medication Dosing Charts
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  • CHADIS
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  • COVID vaccine Ages 6m-5 years

Well Visit Forms

Please complete and submit these HIPPA compliant forms prior to your child/children’s well visit each year

Wavier for Vision Testing (Ages 1 and 2) (Does not apply to patients with Husky insurance)

Wavier for Hearing and Vision testing (Ages 3 and older) (Does not apply to patients with Husky insurance)

Teen Discussion/CHADIS waiver (Ages 13-17)

Waiver for non-covered services  Use this form to agree to services provided in our office for baseline screening EKGs and ImPACT concussion testing.

Acknowledgement of Financial Policy.

Click here to review Financial policy

Acknowledgement of Receipt of  Notice of Privacy Practices

Click here to review Notice of Privacy Practices

Upload a copy of your insurance card

Complete this form if you need to update any demographic or insurance information (eg. address, email address, insurance information)

Waiver to speak to parents/guardians of patients 18y and older

Waiver for portal access for parents/guardians of patients 18y and older

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Contact Details

Bay Street Pediatrics

156 Kings Highway North, Suite 3
Westport, CT 06880-2400


Phone: 203-227-3674

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