HERSHEY PEDIATRIC
CENTER
In accordance with the Governor's order,
we will continue to ask that everyone
coming into the office wear a mask
if they are 3 years old or older.
441 East Chocolate Avenue
Hershey, PA 17033
717-533-7850
717-533-8294 FAX
For answers to frequently asked questions about Covid -19 Vaccines CLICK HERE
Also CLICK HERE to learn about some of the schedule changes and protocols
that we are implementing during the school year to help protect patients and staff.
Please click here for your scheduled telehealth appointment.
To learn more about our telehealth visits click here.
PATIENT FORMS
1. New Patient Form (PDF file)
You can print out and complete in advance of your first office visit or next appointment.
2. Financial Policy for our patients (PDF file)
3. Fee Schedule for office visits (PDF file)
5. Regarding Insurance Form (PDF file)
6. Important Insurance Information (PDF file)
7. Receipt of Notice of Privacy Practices and Consent to Bill Insurance (PDF file)
8. HPC_Patient Portal Info & SignUp Form
9. Medical Record Release Form (PDF file)
10. Modified Checklist for Autism in Toddlers (PDF file)
11. Child Development - Ages & Stages Questionnaire 3rd Edition (PDF file)
12. 9 mos. Ages & Stages Questionnaire
13. 18 mos. Ages & Stages Questionnaire
14. 30 mos. Ages & Stages Questionnaire
The forms in PDF file format require Adobe Acrobat Reader to view and print. This software is provided free of charge and you may download the latest version by clicking on the 'Get Acrobat Reader' button below.
Access All Your
Info Online:
- Prescription Refills
- Appointments
- Health Records
