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Transfer Records

TRANSFER IN – Records TO Village Pediatrics

If you are interested in making Village Pediatrics your child/children’s medical home, please read the “Are We a Good Fit” page to review our policies, then complete this survey to that we can ensure that we are a good match for your family.
If you have been accepted to the practice, we are excited to have your family join us! Please complete the following:  
All of these forms can be completed online and returned securely through our website.  Alternatively, you can print and mail, email or fax your information to us (though we cannot guarantee privacy in these formats.)

TRANSFER OUT – Records FROM Village Pediatrics

We are so sorry to see your family go! We wish you the best and want to make the process as streamlined as possible.
  • When you have chosen a new provider, download, complete, and provide us with a signed Medical Records Release Form.
  • Your request to have your medical records transferred will be completed within 14 business days, and you will be provided with a printed medical care summary along with a disc containing all Village Pediatrics medical records for each child requested.
  • If you need information regarding immunizations, growth records, allergies, lab results and medical diagnoses faster, you can access this all through the MyKidsChart portal.