New Patients

Patient Forms, Map and Directions to our Bingham Farms and West Bloomfield Offices

Thank you for choosing Medical Center Pediatrics as your child's medical home, where we always provide a comfortable, caring environment so our patients and their families can feel at ease. We've included helpful items on this page to ensure you and your child's first trip to our office is
productive, stress-free and enjoyable. 

Mission Statement

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.

If you're preparing for your child's first visit, you can do a few things to help expedite the appointment. Please provide the following information
when you arrive for your visit:

  • Insurance cards
  • Complete immunization records
  • Medical records from your previous pediatrician

Patient Forms

We are happy to provide our office forms for convenient electronic completion. Please complete the forms below. Questions about our forms?
Please call our office and our courteous staff will assist you in preparing for your child's first visit.


In order to view or print these forms you will need Adobe Acrobat Reader installed. Click here to download it: Get Adobe Reader

  • Registration
  • Release of Information
  • Financial Agreement
  • Medical History
  • Vaccine Policy
  • HIPAA Notice and Privacy Acknowledgement
  • HIPAA NOTICE
  • Our compassionate pediatricians do whatever it takes to make every visit to our office a pleasant and relaxed experience.   We invite you to review our staff page in order to get to know our doctors. We look forward to meeting you.

    Contact Us

    Our Locations

    Find us on the map

    Office Hours

    Find Out When We Are Open

    Medical Center Pediatrics - Bingham Farms

    Monday:

    8:30 am-5:00 pm

    Tuesday:

    8:30 am-5:00 pm

    Wednesday:

    8:30 am-5:00 pm

    Thursday:

    8:30 am-5:00 pm

    Friday:

    8:30 am-5:00 pm

    Saturday:

    8:30 am to 12:00 Noon (FOR SICK VISITS)

    Sunday:

    8:30 am to 12:00 Noon (FOR SICK VISITS)

    Medical Center Pediatrics - West Bloomfield

    Monday:

    8:30 AM-5:00 PM

    Tuesday:

    8:30 AM-5:00 PM

    Wednesday:

    8:30 AM-5:00 PM

    Thursday:

    8:30 AM-5:00 PM

    Friday:

    8:30 AM-5:00 PM

    Saturday:

    Closed

    Sunday:

    Closed