Reading Pediatric Associates

52 Haven Street
Reading, MA

New Patient Forms

We welcome you to our practice and look forward to providing the best service to you and your family.

What to do before your first visit:

  • Visit our Insurance & Billing page, under Resources, to verify that we accept your insurance.
  • Call your insurance carrier and change your child’s primary care physician to one of our providers.
  • Request your child’s Medical & Immunization Records from your previous physician. You can use our Records Release From Previous Practice. Fill out this form and fax it to your previous practice to request your child’s records.
  • Read our Notice of Privacy Practices Form.
  • Fill all new patient forms prior to your visit.  
  • Once we receive a copy of your records and these forms are completed, we will contact you to schedule an appointment.
  • Remember to bring your child’s insurance card so that it can be scanned in your records.

New patient forms are  labeled N1-N4.  

Developmental Screening Forms

Please fill out these forms prior to your well visit

In an effort to reduce your waiting time during your visit, we ask that you take a few minutes to fill out the screenings that pertain to you or your child’s age prior to your visit.

Reading Pediatrics uses certain developmental screenings as tools for the early recognition and treatment of children with any developmental or behavioral disabilities such as autism, intellectual disabilities, or Attention-Deficit/Hyperactivity Disorder.  

These screenings can be used to tell if your child is learning basic skills when they should, or if there might be any concerns in their development.  Your child’s doctor may ask you questions or talk and play with your child during an exam to see how he or she learns, speaks, behaves, and moves.  Since there is no lab or blood test to tell if your child may have a delay, the developmental screenings will help tell if your child needs to see a specialist.  In addition to developmental screenings at the early stages of life, we also use screenings to test for depression, anxiety, and social determinants of health.

Developmental forms are labeled CK0-CK9.  


As of January 2021, Reading Pediatric Associates & Family Counseling Associates partnered to make Behavioral Health an integral part of your child’s care.

This partnership has provided Psychological Services on site, alongside, and in collaboration with the providers at Reading Pediatric Associates who care for your child. We are thrilled to have Nicole Shanahan LMCH and Amanda Nortrup LMCH in our office. Nicole and Amanda are both available on site to provide consultation, evaluation, education, brief treatment and referral guidance for children and families. Nicole will is available Monday and Wednesday afternoons and Amanda on Friday afternoons. This is all happening in coordination with the Reading Pediatric Associates staff you have always known.

Nicole and Amanda will both be available for questions, concerns, or for help with:

Worry, Anxiety, Phobias, Panic & OCD
Shyness & Selective Mutism
School Resistance
School or Learning Difficulties
Conduct Problems
Adjustment Problems
Pain, Health & Medical Conditions
Tics & Habit Control Problems
Body Image & Disordered Eating
Family Crises
Parent-Child Conflicts
Sibling or Peer Group Conflicts
ADHD consultation
Developmental consultation

If you or your child’s PCP believe a consultation may be helpful we can

Introduce you to our Behavioral Health Provider at the time of your visit
Schedule a future appointment for your or…
You may call Reading Pediatric Associates to help you schedule an appointment

Before your first visit please register below:

Record Request Forms

Whether you’re new to our practice or need to leave our practice, you can use the forms below to facilitate the process.

Use our Records Release Form to have your records mailed over to us from your current practice.

If your child has reached the age of 24, we request they seek an adult primary care physician.  We feel at that age they would be better served by a health care provider that specializes in adult health.  Please fill out the Record Request Form.  We are happy to have provided care for your child over the past several years.  

You have the option to either have your records printed on paper, and mailed to you or have them sent through the patient portal.

                                                                                                     Records Printed On Paper:

If you choose to have your records printed on paper include a $25 fee per child.    You can call our office and we will accept payment over the phone.  Once we receive this signed form and a payment, we will mail out the records. 

                                                                                           Records Sent Through Patient Portal:

To have your records sent through our patient portal, you must have been registered with us prior to this request.  Please contact us if you have forgotten your username or password and we will be glad to reset the account for you.  We charge a fee of $10 per child to send your records as a pdf attachment through the portal.   Once we receive this signed form, a payment, we will send you your records.

To request your records on-line: 

  • Sign into the Patient Portal
  • Click on patient forms
  • Go to Record Request Z2

To request records using our paper form: 

Fill out form below and mail it, fax it to 781-944-0232, or stop by the office to drop it off. 

Referral & Prior Authorizations

In order for us to process a referral or prior authorization we will need the following information:

  • We need the NPI number of the physician you have been referred to see.  Visit the NPI Registry page for this information. 
  • We need your correct insurance information on file.
  • We need accurate appointment and specialist information. 
  • Referral & prior authorization processing may take up to 7 business days.
  • Our preferred referrals are for Winchester IPA and Tufts Medical Center specialists. 

Referral & Prior Authorization form is labeled Z1.