New Pediatric Patients

DuPage Pediatrics, Ltd. welcomes new patients. Choosing the right pediatrician for your child is one of the most important decisions you will make. By selecting DuPage Pediatrics, Ltd. you can feel confident and comfortable that you have made the right decision.

To understand what to expect for your child's first visit to our practice, please read through this page.

Our Mission

Our practice is working together to build life-long relationships between our staff and our patients by consistently providing our patients with compassion, excellence and value. To fulfill this mission, we are committed to:

  • Improving the lives of the children we serve by providing quality care in a child-centered environment.
  • Listening to our young patients and their families who we are privileged to serve.
  • Guiding our patients along a path of optimal health and wellness.
  • Continually pursuing excellence at all levels through continuing education.

What to bring to your first visit?

We work hard to ensure that your child receives prompt medical care in a comfortable, child-friendly office setting. To help expedite the first appointment, we ask that you please bring your child's immunization records and be prepared to complete paperwork regarding your family medical history, your child's medical history, and insurance information.

Patient Forms

We are also happy to offer you the option to download, print and complete our office forms to reduce wait times during your first appointment.

Forms for New Patients (In addition to the forms directly below, please complete the form(s) in the "General Forms for All Patients" specific to patient's age if patient is coming in for a well exam.)  


General Forms for All Patients

Exam for 2-month-old:

Exam for 9-month-old: 

Exam for 12-month-old, 3-year-old, 4-year-old, 5-year-old (preschool), 6-year-old:

Exam for 18-month-old:

Exam for 2-year- old:

Exam for 2 1/2- year- old (30-month-old) :

Exam for Kindergarten:

Exam for 7 through 10- year-old: 

Exam for 6th Grade, the 9th Grade/HS Freshman:

Exam for 11 years and over:

Patients 18 years old and over:

Information for College Students about Meningococcal B and Meningococcal Conjugate-As of 2018, some states, including Indiana,* require all students attending residential campuses at colleges to be immunized against Meningococcal disease by receiving the following vaccines:

  • Meningococcal Conjugate-one dose on or after 16th birthday
  • Meningococcal B (Brand name-Trumenba)-2 doses 6 months apart or thereafter for students 10-25 years old

*Check with your school before attending for their requirements.

Leaving the Practice:

Releasing records FROM another office TO Dupage Pediatrics:

Authorization to Keep a Credit/Debit/HSA Card on File

Authorization to have someone other than a parent or legal guardian bring in a child for care:

HIPAA Notice of Privacy Practices: 

  • Click here to view the HIPAA notice for DuPage Pediatrics.    

Vaccine Policy Acknowledgement:

In order to view or print these forms, you will need Adobe Acrobat Reader installed. Click here to download it.


What to Expect

On the day of your child's first visit to our office, we recommend arriving a few minutes early. This allows extra time for finishing up any registration forms and ensures you have plenty of time to get acquainted with our staff and office. We look forward to meeting you and joining with you to help your child maintain optimal health.