New Patients

On behalf of the entire Division of Pediatric Gastroenterology at Hasbro Children's, we feel privileged to care for your child.

Medical History Forms

Please fill out one of the following three medical history forms according to your child's age, and bring to your first appointment. 

• Children from 0 to 5 (PDF)
• Children from 6 to 12 (PDF)
• Children 12 and over (PDF)

Additional Forms

• Authorization for use of protected health information (PDF)