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Our goal is to make your family’s healthcare experience as smooth as possible. You’ll find what to expect during appointments, the paperwork you'll need and information about vaccination schedules below. We also offer resources for managing common childhood illnesses and tips for supporting your child’s healthy development. Our goal is to empower you with the knowledge and support you need to make the best decisions for your child’s health.

New Patient Information

New Patient Registration Packet

We are working on a HIPAA-compliant online submission method. In the meantime, you can print this packet and bring it to your first appointment. Emailing is not recommended or HIPAA-compliant.
Any forms emailed are at the patient's own risk.

Please make sure the form is complete before your
scheduled appointment time. 

A copy of this packet is available at our front desk for those without access to a printer. Please review it online so you have the necessary documentation and plan to arrive 30 minutes early if completing in office. 
 

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​​©Jefferson Pediatrics and Family Medicine

3919 W Jefferson Blvd., Fort Wayne, IN 46804​

contact@jpfm.org

260-436-7722​​

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