Niki Saxena, MD and Eileen Chan, MD

Laura Chiang, MD | Leslie Sue, DO | Jigna Sangani. MD

Suzanne Einsiedl, PNP | Jessica Rosenberg, PNP

Laura Breckenridge, PNP

801 Brewster Ave | Suite 175

Redwood City | CA 94063

Tel: (650) 216-7794 | Fax: (650) 216-7796

Pediatric Wellness Group © All rights reserved. Design by The Verden Group

You can access the Medical Record Transfer Form and the Patient Registration Forms by clicking on the PDFs, below.

Patient Registration

Medical Record Transfer Requests

If you do not have access to a printer, you can fill out a form at the office, or you can request that we mail you forms by filling out our online Contact form.

Patient Registration

Requests for copies of your child’s medical record must be made in writing to your doctor’s office, must include your original signature, and must be hand-delivered, mailed, or faxed.

If you are a new patient transferring from another practice

All patients need to fill out our patient registration forms, EVEN THOSE WHO TRANSFERRED FROM KID KARE MEDICAL.

The patient registration packet consists of:

- Patient demographics and guarantor registration

- Patient family medical history form

- An arbitration agreement

Please completely fill out all the required information, then bring the forms along with your insurance card to the visit.

Go to online Contact form >>

and Transfer