Windham Pediatrics, LLC | 150 Mansfield Avenue, Willimantic, CT 06226 | Tel: 860-456-1279

Patient Forms

We continue to have many of our forms online and available for download for your convenience. In addtion, We are pleased to announce that we now offer an online service for submitting patient information forms, scheduling appointments and requesting copies of your child(ren)'s immunization records.

Download and Print

The following forms are available for download. You may print and fill them out at home, then bring into our office. Please check with our office for which forms you need for your next visit.

Submit Online



Submit Patient Information Forms

Keep your child(ren)'s contact, guardian, and insurance information up to date online.

Request Immunization Records

Request copies of your child(ren)'s immunization records online.

Request a Non-Urgent Appointment

Request your next appointment with our office.

These forms may be submitted online to our practice. In order to fill out secure forms online, you will need to create an online forms account by providing your name and e-mail address and creating a password to access your secure forms. If you have not yet created an online forms account, please click on the link below:

Create Online Forms Account

In order to request an appointment or copy of your child's immunization record, you must first complete the patient information form.