(585) 223-6111 PATIENT PORTAL Patient Forms Below is a list of downloadable PDF forms. Feel free to fill out any of the forms before your appointment.  Child Patient Health Information Authorization Form  Meet The Doctor Interview Form  Motor Vehicle Accident Form  Motor Vehicle No-Fault Law Form  Newborn Information Form  New Patient Form  Prenatal Interview Form  Ages & Stages Questionnaire for 2 ½ year well visit  PHQ-2 and 9  SCARED Parent Form  SCARED Child Form Telemedicine Forms Please complete the forms electronically and email them to telemed@fairportpediatrics.com  ADHD Rating Scale Adult  CES D Kids  Edinburgh Postnatal Depression Scale  GAD7 Questionairre  M-CHAT  PHQ-9 Modified Teens  PHQ-9 Adult  Vanderbuilt Parent Rating Scale SCHOOL/SPORT/CAMP FORMS New York State mandates physical examinations for students entering the following grades:  Kindergarten  2nd grade  4th grade  7th grade  10th grade  first year of college Sports, summer camps, and other activities usually require annual physicals. We will complete a physical form for you at the time of your child’s annual physical exam and ask that you keep a copy for your future needs. Have a Question? Feel free to contact us. Phone: (585) 223-6111 Fax: (585) 223-0878 CONTACT US Fairport Pediatrics Address Fairport Pediatrics, LLP 460 CrossKeys Office Park Fairport, NY 14450-3590 GET DIRECTIONS Connect With Us Phone: (585) 223-6111 Fax: (585) 223-0878 Office Hours Monday - Friday: 8 am - 4:30 pm Saturday: 8 am - 11:30 am Extended hours Sunday: 9:30am – 11:30am Proudly serving patients from Monroe, Wayne and Ontario Counties. © 2021 Fairport Pediatrics. LLP. All Rights Reserved. Site Map Site by

(585) 223-6111 PATIENT PORTAL All patients are seen by appointment, and we ask that you call in advance so an appointment time is reserved for your child. If you wish more than one child to be seen, please specify this when the appointments are made so that enough time can be scheduled for your family. If you are unable to keep an appointment, please notify us as soon as possible. All regular appointment and scheduling needs may be met with our 24-hour phone line. During normal business hours, please call our main number (585) 223-6111 and press option “6” for all non-emergent appointments. If you think of scheduling an appointment for your child when our office is closed, after 4:30 pm, you can call our main number (585) 223-6111 and press option “6” to leave a brief message and a phone number where we may reach you early the next business day. Our phone secretaries begin returning evening phone messages at 7:30 am. Have a Question? Feel free to contact us. Phone: (585) 223-6111 Fax: (585) 223-0878 CONTACT US Fairport Pediatrics Address Fairport Pediatrics, LLP 460 CrossKeys Office Park Fairport, NY 14450-3590 GET DIRECTIONS Connect With Us Phone: (585) 223-6111 Fax: (585) 223-0878 Office Hours Monday - Friday: 8 am - 4:30 pm Saturday: 8 am - 11:30 am Extended hours Sunday: 9:30am – 11:30am Proudly serving patients from Monroe, Wayne and Ontario Counties. © 2021 Fairport Pediatrics. LLP. All Rights Reserved. Site Map Site by