New Patient Forms. Dr. Giridhar Veerula, Board Certified Integrative Pediatrician. Dr. Vijay Veerula, Board Certified Osteopathic Family Medicine Physician. Primary Care. Fort Wayne, IN. Holistic healthcare for patients of all ages. Accepting new patients. Jefferson Pediatrics & Family Medicine. JPFM New Patient Forms 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.

Dr. Giridhar Veerula, Board Certified Integrative Pediatrician. Dr. Vijay Veerula, Board Certified Osteopathic Family Medicine Physician. Primary Care. Fort Wayne, IN. Holistic healthcare for patients of all ages. Accepting new patients. Jefferson Pediatrics & Family Medicine. JPFM The Patient Experience We would greatly appreciate it if you could take a moment to share your experience with us. Your feedback helps us improve our services. Thank you for being a valued part of our community! Rate Us First Name Last Name Email Name of Physician or Practitioner : Message I want to subscribe to the newsletter. Send We truly appreciate our patients for sharing their experiences & feedback. Your insights are essential in helping us improve & grow our practice.

Resources For Parents MMR Vaccine Information The MMR vaccine protects against measles, mumps, and rubella—three contagious viruses that can cause serious complications like pneumonia, hearing loss, or birth defects if left unvaccinated. Read More Measles Measles is a highly contagious disease caused by the measles virus. The infection can lead to serious and sometimes fatal complications. Fortunately, measles is a vaccine- preventable illness. Read More Mumps Mumps is a contagious viral infection that primarily affects the salivary glands, causing them to swell and become painful. Read More Rubella Rubella is a contagious virus that causes a red rash, low-grade fever, and swollen glands. It spreads through respiratory droplets when an infected person coughs or sneezes. Thanks to the MMR (measles, mumps, rubella) vaccine, rubella is now rare—but outbreaks can still happen, especially among unvaccinated individuals. Read More MMR Vaccine Information The MMR vaccine protects against measles, mumps, and rubella—three contagious viruses that can cause serious complications like pneumonia, hearing loss, or birth defects if left unvaccinated. Read More Measles Measles is a highly contagious disease caused by the measles virus. The infection can lead to serious and sometimes fatal complications. Fortunately, measles is a vaccine- preventable illness. Read More Mumps Mumps is a contagious viral infection that primarily affects the salivary glands, causing them to swell and become painful. Read More Rubella Rubella is a contagious virus that causes a red rash, low-grade fever, and swollen glands. It spreads through respiratory droplets when an infected person coughs or sneezes. Thanks to the MMR (measles, mumps, rubella) vaccine, rubella is now rare—but outbreaks can still happen, especially among unvaccinated individuals. Read More