Candlewood Valley Pediatrics

For Our Patients

Downloadable forms (in PDF format)

We encourage you to print out the appropriate forms from the list below, fill them out at your leisure in the comfort of your own home or office and then simply bring them with you to your visit. This will save valuable time when you arrive for your appointment.

Forms and More Forms!
College, School, Camp, Sports Forms

During the spring and summer months, Candlewood Valley Pediatrics wil be filling out hundreds of Camp and School forms. Many of these forms are unique and require specific information. It is of utmost importance that each and every form be completed accurately. Our medical records staff respectfully requests that you allow at least 5-7 days advance notice for each form to be completed.

In order to expedite the completion of each form, please make sure to complete your portion before submitting the form to our office. Please PLAN AHEAD. We cannot guarantee that late requests can be honored.

For the benefit of our patients, we do not charge for the completion of your forms, and we ask that you respect our request for ample advance time.

Privacy and the Health Insurance Portability and Accountability Act (HIPAA)

For your convenience and information, our Notice of Privacy Practices (HIPAA) is available in PDF format. Please take a few moments to review this notice. To expedite your appointment, we encourage you to print off the Acknowledgement of Receipt of Notice of Privacy Practices, sign it, and bring it with you to your appointment.


For our patients' convenience, Candlewood Valley Pediatrics (CVP) offers daily, evening and Saturday appointments (Saturday hours are reserved for sick patients only). Please note that the CVP physicians are on call 24 hours a day, 7 days a week.

Appointments for any of the following types of appointments may be made by calling the office at (860) 355-8190.

The telephones are answered by our office staff during the following times (please note that we are closed from 12:45 pm – 1:45 pm):

    • Monday through Thursday, 8:30 am - 5:45 pm
    • Friday, 8:30 am - 5:30 pm
    • Saturday mornings

If you have an emergency, or need to speak to the physician on call, the answering service will contact the physician on call for you.

Patient emergencies sometimes occur that may interrupt the normal appointment schedule. If a delay is likely to result because of an emergency, we will contact you as soon as possible and either reschedule your appointment with a different physician, or reschedule the appointment at a time that is most convenient for you.

As a courtesy to our patients, our office attempts to contact every patient to remind them of their appointment. However, it is your responsibility to make a note of your child’s upcoming appointment, and to arrive for the appointment on time.

A fee will be charged for any appointment not cancelled by 3 pm of the previous day, or by 3 pm on the Friday before a Monday appointment.

When a patient does not show as scheduled, three people get hurt:

    • Your child because they won’t get the care they need as prescribed by their physician
    • The physician who now has a space in their schedule since the time was reserved for your child personally
    • Another child who could have been scheduled if there had been proper notice

These fees are not covered by insurance and therefore you will be responsible for payment.

No show/cancellation Fee Schedule

Sick visit appointments = $25.00
Physical appointments = $50.00

Insurance & Billing Information

Candlewood Valley Pediatrics participates with most major insurance companies, as listed below. Important criteria on which we base our decisions are the availability of specialists in the referral network and on the needs of our patients and community.

There are many rules, regulations and limitations imposed by each insurance company, and further within the different plans offered. The specific benefits negotiated with these insurance companies by individual employer groups make it impossible for us to navigate through their networks. We ask that you become familiar with your specific plan and the benefit package that has been chosen for you and your family.

It is important for you to understand that our physicians recommend treatment based on the individual needs of each patient. There may be times that your insurance company may not pay for these visits and/or procedures that can be associated with the visit. Please understand that our main concern is for your child, and our responsibility is to provide the best possible medical care for him/her. We do not base our medical decisions on the stipulations of the insurance companies.

Insurance companies with which we currently participate:

Commercial: Federally-Funded Medicaid Plans
  • Aetna
  • Anthem Blue Cross/Blue Shield
  • Beech Street
  • Benesight
  • BlueCare
  • CCN
  • Connecticut Healthplan
  • Cigna
  • Connecticare
  • Definity
  • Federal Employee Program
  • First Health
  • Golden Rule
  • HCVM
  • Healthnet
  • Multiplan
  • Northeast Direct Health
  • PHCS
  • Pomco
  • S&S Healthcare Strategies
  • United Healthcare
  • Husky A/B
  • Title 19

If you do not see your insurance company on the list, we will gladly file your insurance for you. Some of these insurance plans are based on deductibles and pay a percentage of the charges. Again, we urge you to contact your individual insurance company and to familiarize yourself with your policy.

Our Billing Staff is available to assist you with any questions or concerns that you may have with respect to your account.