Hershey Pediatric Center is dedicated to providing you with the highest quality, cost effective medical care. We accept all major credit cards and offer payment installments.


Your First Office Visit

Thankyou for considering us for your child's patient care. Please assist us by providing the following information when you arrive for your first office visit. You can click on a link to download a PDF file version of the form.

  • Ethnicity form - click here

  • New Patient form- click here

  • Medical Release form - click here
    (Note: this should be mailed to your previous Doctor before scheduled appointment)

  • Receipt for Notice of Privacy Practices & Consent to Bill Insurance - click here

  • Financial Policy - click here

  • Insurance card

If you would like to schedule an appointment please call 717-533-7850. Please arrive 15 minutes prior to your scheduled appointment. It is now our policy to have you bring and present insurance cards for your children at all visits. 


Save time when visiting the office and download all your patient forms here
For the most up-to-date information on our accepted private
health insurance plans
contact our clinic directly at 717-533-7850 ext 4
Renew prescriptions by phone or on-line -
click here