(630) 810-0900

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

Office Policies, Financial Policies and Consent to Treat
Vaccine Policy
Vaccine Policy Acknowledgement
Initial History Questionnaire
New Patient Information
Authorization to Treat a Minor
Demographic Information
TB Form only if child is 12 months or old
RSV only if child is 2 years old or younger


General Forms for All Patients
Exam for 2 month old: Edinburgh
Exam for 9 month old: Infant Development Chart
Exam for 12 month old, 3 year old, 4 year old, 5 year old (preschool), 6 year old: Lead Form, Lead Zip Code List, TB Form
Exam for 18 month old: M-Chat Form
Exam for 2 year old: Lead Form, Lead Zip Code List, TB FormM-Chat Form
Exam for Kindergarten: Lead Form, Lead Zip Code List, TB Form, Updated HIstory Questionnaire
Exam for 7 through 10 years old: TB Form
Exam for 6th Grade, 9th Grade/HS Freshman: TB Form, Sports Participation and Updated History Form, Updated HIstory Questionnaire, Patient Health Questionnaire (12 years and over ONLY)
Exam for 11 years and over: Sports Participation and Updated History Form, TB Form, Patient Health Questionnaire (12 years and over ONLY)
Patients 18 years old and over: HIPAA, Office Policies, Financial Policies and Consent to Treat, Contact Form, Demographic Info., Vaccine Policy Acknowledgement

Leaving the Practice: Record Release Request
Releasing records FROM another office TO Dupage Pediatrics: Release for Incoming Records
Authorization to have someone other than a parent or legal guardian bring in child for care: Authorization to Treat a Minor
HIPAA Notice of Privacy Practices: Click here to view the HIPAA notice for DuPage Pediatrics.    
Vaccine Policy Acknowlegement: Signature Page

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.


View map and directions to our location and office hours.

DuPage Pediatrics, Ltd.
1306 Plainfield Rd
Darien, IL 60561
(630) 810-0900
Fax - (630) 810-0937

Find Us

Monday to Thursday 8 am - 8 pm
Friday 8 am - 7 pm
Saturday 9 am - 12:00 pm
Sunday - closed


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