Records In
Records Release Authorization to Transfer Your Child's Records to West Broward Pediatrics From Your Child's Previous Pediatrician.
To transfer your child's records to our practice from your child's previous pediatrician, please call our office at (954) 423-2300 or (954) 384-8885. Our staff will assist you with this process.
On-line Option
To complete your release through our secure on-line website, click the link below:
Print Option
To print your release click the link below and complete your release. E-mail your form to [email protected] or fax to (954) 424-4200.
Records Out
Records Request to Transfer Your Child's Records Out of West Broward Pediatrics to Another Provider.
To transfer your child's records to another provider - please call our office at (954) 423-2300 or (954) 384-8885 for assistance. Our staff will be happy to assist you with this process.
Records Release Authorization for Specialist Physician
Records Release Authorization for Specialist Physician to Forward Your Child's Records to West Broward Pediatrics.
From time to time, your child may need to see a specialist. In order for us to obtain your child's report or records, you may be asked to complete the Records Release Authorization for Specialist Physician below. Please do not complete this form unless we have requested your child's records from a specialist physician. If you have any questions regarding the Records Release Authorization for Specialist Physician, please call our office at (954) 423-2300 or (954) 384-8885. Our office will assist you with this process.
On-line OptionTo complete your release through our secure on-line website, click the link below:
Print Option
To print your release click the link below and complete your release. E-mail your form to [email protected] or fax to (954) 424-4200.
Records Release for Hospital or Other Medical Facility
Records Request for Hospital or Other Medical Facility to Forward Your Child's Records to West Broward Pediatrics.
If your child has visited a hospital, been admitted to a hospital or has been treated by or had test(s) performed at a medical facility, you may be asked to complete the Records Release below. If you have a newborn baby we may request that you complete the form below upon booking your first appointment with our office. Please do not complete this form unless we have requested your child's records from a hospital or other medical facility. If you have any questions regarding the Records Release for Hospital or Other Medical Facility, please call our office at (954) 423-2300 or (954) 384-8885. Our office will be happy to assist you.
On-line Option
To complete your release through our secure on-line website, click the link below:
Print Option
To print your release click the link below and complete your release. E-mail your form to [email protected] or fax to (954) 424-4200.
