By providing information on this secure form and clicking "ENROLL" below, you are requesting Small Town Pediatrics to create a family account for you and your child(ren.) To complete this process we may need to contact you by phone, text or email for clarification or additional information.
There is no charge to you nor your insurance for setting up this account.
When you enroll, you will be directed to another form to reveiw and sign our patient policies.