Our Forms

At present, we are only accepting Newborn Babies less than 2 Months of Age at this time.

To request a daycare, school, sport or camp form, please email ncpnurse@gmail.com your child's name and date of birth.  We will reply to email with the completed form in 3-5 days. We do not submit these forms directly to the school or camp. Physical examinations are required prior to entry into pre-school (each year), prior to kindergarten, and during grade 6 (before entering grade 7) and during grade 9 (before entering grade 10). All student athletes planning to try out for a sport must have a current physical (dated within 13 months from tryout dates). Please plan ahead.

The NICHQ Vanderbilt Assessment Scales are used to help assess ADHD symptoms of inattention and hyperactivity along with conduct disorder, oppositional defiance disorder, anxiety, depression and academic performance. They can be returned to ncpnurse@gmail.com .

These forms can be returned to ncpnurse@gmail.com .

NHS Athletics Concussion Policy states all athletes who are diagnosed with a concussion, must be cleared of all academic accommodations prior to resuming any physical activity and the return to play protocol.  Athletes are permitted to still be in the process of making up missed assignments, but they can not have testing accommodations in place or be allowed increased time for assignments in order to begin the return to play process.

Newtown Center Pediatrics pledges that all patients will receive our best medical care from birth through college, regardless of race, color, national origin, sex, gender-identification, age, or disability.