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Forms & Policies

Parent Forms

All requests will be processed in 2-3 days. Please call the office at 
(585)442-1421 if you are requesting a same day appointment.

Before your appointment with us, quickly and conveniently access patient forms from our practice.

Online Patient Forms

Download Patient Forms

To view the forms listed below, you will need Adobe Reader. You may download Adobe Reader for free at Please bring your completed forms with you to our office at the time of your visit.

Download Office Policies


As with any professional office, our goal is to serve our patients efficiently and effectively. In order to achieve these goals, we request that each patient do their part by cooperating with the policies of our practice regarding insurance and payment.


Lewis Pediatrics accepts the following insurances:

  • Aetna
  • Blue Cross/Blue Shield
  • Child Health Plus
  • Cigna
  • Fidelis
  • Molina Healthcare
  • MVP Healthcare
  • Tricare
  • United Healthcare

Your Child’s Health is our #1 Priority.

Request your appointment today with Rochester’s best pediatric group!