Elliot Pediatric Gastroenterology: Patient Information

To schedule, cancel, or reschedule an appointment, please call our office at 603-663-3222 or log into your MyChart account. If you do not have a MyChart account, please click here to sign up.

Insurance Card, including your policy number and/or Medicare/Medicaid card.

Co-payment is expected when you check in. For your convenience, we accept checks, cash, Visa, Mastercard, Discover, and American Express.

Prescription Medication(s) in their original bottles or a list of all medications, including over-the-counter medications, vitamins, and supplements, and the amounts you take.

To refill a prescription, please call our office at 603-663-3222 or log into your MyChart account. If you do not have a MyChart account, please click here to sign up.

Please allow 48 hours to refill medications.

To request a referral, please call our office at 603-663-3222

or log into your MyChart account. If you do not have a MyChart account, please click here to sign up.

Cyclic Vomiting Syndrome Association
www.cvsaonline.org
Click on Resources and What is CVS

North American Society for Pediatric Gastroenterology, Hepatology & Nutrition
naspghan.org

Celiac Disease Foundation - Allergies
www.celiac.org

Inflammatory Bowel Disease – Crohn’s Disease and Ulcerative Colitis
www.ccfa.org
www.ucandcrohns.org

If you would like a copy of your medical record, please download and complete the form below. Completed forms can be mailed, faxed, or brought back to our office.

Medical Records Release Form