NICU Developmental Follow Up Intake Form

NICU Developmental Follow Up Intake Form

Congratulations on the birth of your baby! Here at Pediatric Health Specialists, we are honored to partner with you in your unique journey raising your precious child.


Your baby will be scheduled for developmental evaluations at our clinic so we can partner with you and your child’s primary health care provider (PCP) to optimize your baby’s developmental milestones.


Your first appointment will be within the first 2 months of discharge from the neonatal ICU. We will need some information from you prior to your first visit so that we can streamline the time you spend in our office.


Please fill out this form so that we can start the process of getting you registered in our system. Some insurance companies require a referral from your baby’s primary care provider (PCP). If that is the case, we can reach out and get this referral from them.


Again, congratulations! We look forward to meeting you and your baby!