(302) 392-2077

New Patient Forms

Welcome to Delaware Modern Pediatrics! We’re so glad you’re here.

To help make your first visit smooth and stress-free, we’ve compiled all the paperwork you’ll need right here. You can download each form, fill it out at your convenience, and bring it with you to your appointment.

*Please note: Old records are helpful, but you do NOT have to transfer records in order to receive care here. Don’t wait for the old records to arrive before scheduling an appointment!

Completing these forms ahead of time allows us to focus on what really matters—getting to know your child and starting care on the right foot.

Doctor working with Child on Handouts | Delaware Modern Pediatrics

Welcome Packet

New to our practice? Please download this package. You can read about our office, and get the forms that we will ask you to complete for us.

Medical Records Transfer Form

If you are transferring your child’s care to our office from another doctor, you may download this form and send it to your previous doctor. (They may charge a fee for copying records.)

Patient Financial Policy

Please read our policy regarding our expectations of family financial obligations towards our office.

Patient Privacy Notice

HIPPA Privacy Notice

After-Hours Emergency Policy

Sometimes parents wonder when it is appropriate to make an urgent call after hours. Here is some guidance.

Family History

It is useful for me to have a brief list of family illnesses. You can complete this form and bring it to your first visit. Check with all your close relatives!

Immunization Refusal

If you decide to delay or decline routine vaccinations, we will ask you to sign this waiver.

Lab Order for Jaundice

If your baby is jaundiced and we discussed drawing bloodwork, print this form. Fill in the name and birth date, and bring it to your lab.

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[Dr. Epstein] is very informative and listens to everything

Dr. Epstein is a great pediatrician. We had our first child recently and was very cautious of who’d we want as a Dr. Needless to say after our first appointment we knew we found the right one. He is very informative and listens to everything.

Rated 5 out of 5 stars
Ethan Caulder

Dr. Epstein is such a great physician

Dr. Epstein is such a great physician. He is always pleasant but straightforward, which I appreciate. He is very current and knowledgeable but has a lot of experience. The entire office is friendly and inviting. I love that when I call with questions or a problem I always talk to a nurse who is both reassuring and informative. Plus after hours emergencies are always handled by the doctor or his PA. I tell all my friends in the area to switch to his office.

Rated 5 out of 5 stars
Katie Varga

With Dr. Epstein in our corner, our experience to raise our little one is so beautiful

I think we are so fortunate to find Dr.Epstein for our little one (our first baby). His expertise have made a real difference. He has got the unwavering dedication. He is truly outstanding. There is exceptional care and kindness at his facility. I am thankful for the positive impact he have made on his through his expertise and compassionate care. With Dr.Epstein in our corner, our experience to raise our little one is so beautiful. We cant thank him enough for being an amazing part of our journey………… We love him and his staff so so so much for being super responsive and accommodative. We made the bestest decision in choosing him and his facility.

Rated 5 out of 5 stars
Rashmika R

Very Professional practice and knowledgeable Doctor

Very Professional practice and knowledgeable Doctor. Truly cares about the Kids.The staff at the practice is amazing

Rated 5 out of 5 stars
Mary Bruce

Dr. E is so knowledgeable and experienced- very level-headed and great with new parents

Absolutely wonderful medical practice! My husband went to Dr. E as a child, and we are thrilled with DMP for our baby. Dr. E is so knowledgeable and experienced- very level-headed and great with new parents. He also takes the time to talk to you, explain things, and answer your questions. You can tell how much he loves his job. This place honestly has much more of a family feel than a larger practice. You can also call in the morning to talk to a nurse, which is great if you aren’t sure if you need to come in or not. After coming here, we would not consider another practice. Highly recommended!

Edited to add that now that we have a toddler, we are even more thankful that we can call and get Nurse Linda if we have a question. Very thankful for DMP!

Rated 5 out of 5 stars
Katie Marie

His office staff and nurses are very friendly and knowledgeable

We have been with Dr. Epstein since our son was born (minus a year or two when he first moved to Glasgow). He is big on education, has a great bedside manner, and takes his time to answer any and all questions you may have. His office staff and nurses are very friendly and knowledgeable. They are very accommodating with scheduling routine as well as sick visits. Their website is very helpful too.

Rated 5 out of 5 stars
Carol Boone

My questions no matter how trivial is answered with care

I had to relocate to nj, and I sorely miss Dr. Epstein and his staff. Getting an appointment is never a problem. My questions no matter how trivial is answered with care. They are all very patient even with my screaming toddler. Each visit is educational and everything done to your child is explained clearly. I wish every doctors office was this nice and informative.

Rated 5 out of 5 stars
Kat T

Delaware Modern Pediatrics has been the best fit for all my children

Dr. Epstein and and his staff are phenomenal. We were new to the area, trying to find new providers. Modern Pediatrics has been the best fit for all my children. Especially my little guy and ADHD. I never leave feeling like I have unanswered questions about treatment and learning so much more on raising healthy, happy kiddos! Thanks Modern Pediatrics!!!

Rated 5 out of 5 stars
iamafrobunny

This is such a nice office and is perfectly themed in each room with kids in mind

This is such a nice office and is perfectly themed in each room with kids in mind. The office staff has been extremely kind in answering my questions as we recently moved back, and I’ve had a great deal in transferring paperwork and giving birth recently. Very glad to have found this pediatrician especially since our last pediatrician did not end on a good note.

Rated 5 out of 5 stars
Victoria Vaden

They explain things well and are very respectful!!

Great practice!!! They put patients first… They explain things well and are very respectful!! It has a small practice feel and staff is knowledgeable…

Rated 5 out of 5 stars
Heather Luszcz

If you are looking for personalized and quality care for your child I highly recommend Delaware Modern Pediatrics!

As a new parent I did a great deal of research prior to picking a pediatrician and my hard work paid off tremendously. Dr. Epstein and Lorna are amazing. At each appointment I never feel rushed all my questions are answered. Both providers are friendly and available even after the office has closed. I am able to schedule an appointment very easily and the office staff is an added bonus. Everyone is very pleasant and helpful. If you are looking for personalized and quality care for your child I highly recommend Delaware Modern Pediatrics!

Rated 5 out of 5 stars
Jessica Savage

Dr. Epstein is a awesome pedestrian every open and aware

Dr. Epstein is a awesome pedestrian every open and aware of my cultural traditions, patient and up to date with new medical information/technology etc. His staff always makes you feel welcome.My children enjoy going and say they are going to be a doctor like Dr. EPSTEIN! If your new parents or looking for a change or just moving in the Delaware area please check Dr. E out.

Rated 5 out of 5 stars
Yanni Williams

They are there for you when you need them.

I love taking my children here. As a new parent things can get confusing and it is nice having a pediatrician that is able to provide guidance. They are there for you when you need them. Dr.Epstien is thorough and willing to answer any questions you may have on child development. Maxine is very sweet and caring, I feel she adds a motherly touch to the practice.

Rated 5 out of 5 stars
Tali L

Dr. Epstein always provided information so you understood & to reference back to

We have been with Dr. Epstein & his staff for 18 years! He is absolutely amazing & dedicated to his patients. My oldest was sick a lot when she was younger & Dr. Epstein never gave up finding a diagnosis & he was persistent with getting specialist at Nemours to help him treat her. During these times, Dr. Epstein was the ONLY doctor who provided medicine to help with comfort as we were searching for answers. He always spends test with you no matter how far behind he is & he is very thorough. Dr. Epstein always provided information so you understood & to reference back to. I wish there were more doctors like Dr. Epstein, truly an amazing doctor! Can’t forget the amazing staff who are always willing to find a way to get you in to be seen & following up with you in a timely manner!

Rated 5 out of 5 stars
Heather McWilliams

Very accurate and professional

Very accurate and professional

Rated 5 out of 5 stars
Lisa Riley

The Best Doctor for kids, I have ever met

The Best Doctor for kids, i have ever met ….thank you for the great services.

Rated 5 out of 5 stars
Govind Suri

Explains everything perfectly, and gives a better understanding!

Love doctor Epstein!!! He’s been my family’s doctor for a long time! Explains everything perfectly, and gives a better understanding! Staff is great as well. They’ll get you an appointment ASAP!

Rated 5 out of 5 stars
Hailey Matheus

A smooth experience from start to finish

Dr. E and the rest of the team are great! My family and I have a positive experience each time we go, even when my kids are sick. Everyone is always very nice and professional. Also, as an added bonus, there’s never a long wait :). It’s always a smooth experience from start to finish.

Thanks, The Taylor’s

Rated 5 out of 5 stars
Latisha Taylor

Just an amazing knowledgeable doctor

Dr epstein is amazing . He’s the first doctor I found for my kids that I love . He takes his time doesn’t rush visits very thorough writes things down to make sure you don’t forget anything . He will stay late just to see my sick kids so I don’t have to make hospital runs . 6 months ago he saw my daughter because she was limping and having hip pain , he was able to tell me what he thought it might be . he got her x-rayed right away they found she needed surgery , thanks to him correctly diagnosing her she had surgery right away and is walked again today without causing any serious long term damage . Just an amazing knowledgeable doctor

Rated 5 out of 5 stars
Stephanie Patton

[Dr. E] is the best pediatrician around!

Dr. E. & his staff are amazing! my kids have been with his office since they were born & I am so lucky to have found him! His office offers 2 waiting rooms, sick & well so germs don’t mix! I have never waiting longer than 10 minutes either. Dr. E takes the time to actually listen to figure out what is wrong with your child! All of the office staff are super friendly! The office & the rooms are super clean and so are all of the toys they offer (toys in every room for your child). His office will always find time to squeeze you in for an unexpected visit! He is the best pediatrician around! I highly recommend him to all my friends and family!

Also they have a website that is constantly updated & Dr. E offers a blog to keep you updated on everything!

Rated 5 out of 5 stars
Kaitlyn Shahan

Best doctor for all kids

Best doctor for all kids

Rated 5 out of 5 stars
Crystal Spence

I love the family environment and the staff are friendly and know their business.

I love the family environment and the staff are friendly and know their business.

Rated 5 out of 5 stars
Andre

[Dr. Epstein] does not hesitate sharing his ocean of knowledge

Dr.Epstein is amazing!! All his suggestions, recommendations have worked like a charm for our 3.5 year old and 7 month old.
What we like the most is , he does not hesitate sharing his ocean of knowledge. He makes sure he answers all our questions and addresses our concerns. He explains why he is suggesting so and so, and the science behind it, so we don’t have to wonder.
The handouts are helpful. We don’t have to look up something online and get scared about something that is not apparently scary.
Sick visit: the nurses on call have always been helpful and we get sick appointments quickly, as early as 15 mins.
Front desk: the front desk staff are very kind and accommodating. They are flexible with schedules.

Rated 5 out of 5 stars
Sahana Varadaraju

We love Dr. Epstein and the entire staff

We love Dr. Epstein and the entire staff. So sad that we had to leave the practice as we moved to a different state. Our little one always loved to go to him. The staff is nice and very quick to reply back in as you have any questions. In case of late hour questions, their helpline is so great and helpful.
Would highly recommend him and his practice.

Rated 5 out of 5 stars
Arushi Bhaskar

The Doctors’, MT’s and office personnel are very professional

The Doctors’ , MT’s and office personnel are very professional. I have no problem getting my two kids in if they are sick. If you notice their wall of all the children they see you will notice how proud they are of the work they provide. They are quick and wait time is not long at all, especially if your child is sick. Anytime I need a form for school filled out, they are done in a quick manor.

Rated 5 out of 5 stars
Kasey Downward

I know my daughter is in well experienced hands

Always so thorough, Dr. Epstein’s website is very useful also, I check it frequently for any concerns I have. Highly recommend, you can call and speak with the nurses over the phone too. I know my daughter is in well experienced hands

Rated 5 out of 5 stars
Anna Patalik

The team at Delaware Modern Pediatrics is wonderful

The team at Delaware Modern Pediatrics is wonderful! They genuinely care about your child and provide unparalleled service and expertise.

My daughter, who is a year and a half, has gotten sick much more often then I would like – so, we have visited the office on a number of occasions for both sick and well visits. Whenever I call with a problem or question, someone immediately responds (even on the weekends) and they always make time to see her in when she is sick.

DMP also has a great website with tons of information for you and how to care for your baby…whether you need to know how much tylenol to give or how to say no when your child is just so cute… they have an informative pamphlet either on their website or in the office.

I really cannot say enough good things about the doctor, the physician’s assistant, the nurse practitioner and all of DMP’s staff. They work hard to keep your child healthy and happy; and, they do a wonderful job.

I would highly recommend Dr. Epstein and the DMP office.

Rated 5 out of 5 stars
Kimberly Brown

I’ve learned so much from him and am really grateful that our kids have received excellent care

Our 2 young boys began seeing Dr. Epstein after we moved to Delaware and he’s superb. We’ve had a handful of well visits, sick visits and video calls together. He made us feel welcomed from day 1 and is a wealth of knowledge while always pleasant. He really takes his time to explain relevant medical conditions like asthma as well as parenting techniques. I’ve learned so much from him and am really grateful that our kids have received excellent care. His office team is also wonderful – so warm and friendly. Highly recommend!

Rated 5 out of 5 stars
Jie Zheng Charles

You feel cared for and you feel your child is cared for

Dr E & all the staff have been nothing short of amazing, whether it be an after hours call or needing to be seen same day for an emergency, or a routine appointment, you feel cared for and you feel your child is cared for. Dr E has always made me feel better with clear answers, and solutions when my son suffered from bad acid reflux. You can just tell he cares. We are moving out of state & my biggest scare is I won’t find a doctor & staff as amazing as this practice. We are going to miss everyone & thankful we had the time with them we did since my sons birth

Rated 5 out of 5 stars
Nina Cheeseboro

My daughter feels comfortable there and receives excellent care!

Dr. E is great. The office staff is very nice and accommodating. The doctor is wonderful with children and does an awesome job. My daughter feels comfortable there and receives excellent care! We are so happy we find Delaware Modern Pediatrics!

Rated 5 out of 5 stars
Courtney Seehusen

We’re very glad we went with Dr. Epstein for our daughter!

We’re very glad we went with Dr. Epstein for our daughter! We’ve been at his office for close to a year now (started when she was 8 months old), and he has consistently been thorough, knowledgeable on all the questions I’ve asked (and I’ve asked a lot) and never rushes a checkup… which is amazing these days for a doctor to choose to do that! I normally feel hustled through at other offices but never at DE Modern. He obviously cares a lot about children and their well-being.

Rated 5 out of 5 stars
Ruth Barnet

Dr. Epstein and his entire staff are so amazing

Dr. Epstein and his entire staff are so amazing. Everyone is kind, caring, and compassionate. I can’t say enough about everyone in that practice. Thank you!!

Rated 5 out of 5 stars
Jeanine Grabowski

Love the people here!

Love the people here! Their all so warm and friendly 🙂!!

Rated 5 out of 5 stars
Amber Capano

This office and Dr. E are amazing

This office and Dr. E are amazing. If you are looking to be not just another number go here. He knows you and your children before he looks at your file. He will answer his phone on weekends, and holidays if you have a question. They have always fit me in the schedule no matter what time I call. I have never been to a better doctor for my children or I than Dr. E.

Rated 5 out of 5 stars
Brian Martonik

It’s very important to find doctors that really care and that you can trust!

I tried multiple doctors before finding Dr. E.. I’m so happy that we found him. He’s awesome and have so much wisdom. We moved from DE but continue to take the ride for our children because he’s truly the best! And can tell he really care for children it’s not just a job he truly care. I thank God for him. It’s very important to find doctors that really care and that you can trust!

Rated 5 out of 5 stars
Cherish Victoria'Rae

Always a good experience at DMP

Always a good experience at DMP. Dr. Epstein and his staff are caring, knowledgeable, and professional.

Rated 5 out of 5 stars
Jerry Polman

Dr. E is phenomenal!

Dr. E is phenomenal! He has been a part of our tribe since my son was born. He is almost 15 years old. I am grateful for his expertise, knowledge, and support. He is a physician that genuinely cares about patients. Keep up the good work!

Rated 5 out of 5 stars
Celine Tata

Always pleasant and accommodating

Never have any issues getting in for a sick visit. Always pleasant and accommodating. Especially when one of our children has a fear of needles Dr Epstein helps tremendously and doesn’t make us feel small when she is shutting down and screaming! Maxine is great as well she handles hard strep tests with grace. Thank you for your patience today and every day.

Rated 5 out of 5 stars
Amanda Pedrick

Very kind and friendly staff

Very kind and friendly staff. Dr and NP are very patient and respectful.

Rated 5 out of 5 stars
Kiersten Jones

Everyone is so kind and nice!

Everyone is so kind and nice! Especially thank you to Brooke, who was nice to us for our visit!

Rated 5 out of 5 stars
Kim 사랑

I can’t recommend this office enough!

I absolutely love this office and dr Epstein. They love my children, always show them kindness, and really enjoy seeing my kids from bottom to top. Dr E has been so helpful to me. As a new mom of an almost 2 year old and 9 month old, I of course am always worried about something or asking a million questions. They have been so patient with me, have not made me feel crazy, so kind to me. They give me freedom to go with the vaccine schedule I want, they give my kids freedom to make choices and don’t stick them in a one size fits all box. He has very helpful tips on parenting and health, and is great with kids. They even answer my 8pm phone calls that are nonsense worrying. I can’t recommend this office enough! Nothing but greatness. It’s not like going to a major office who doesn’t remember you or your children, it’s a practice that knows you and your children by name, and looks out for you.

Rated 5 out of 5 stars
Olivia East

Such an amazing and caring team from the front desk to the doctor/ nurse practitioner

Thank you so much to the wonderful staff at Delaware modern pediatrics for getting my daughter in so quickly when she was sick. Such an amazing and caring team from the front desk to the doctor/ nurse practitioner

Rated 5 out of 5 stars
Katie Burnett

Delaware Modern Pediatrics has been an absolute blessing for our family!

Delaware Modern Pediatrics has been an absolute blessing for our family! Dr. E is exceptional — knowledgeable, thorough, and genuinely caring. Always explains things clearly. I truly appreciate how he takes a holistic approach, addressing not just the symptoms but the overall well-being of my children.

Scheduling is easy, communication is smooth, and the follow-up care is top-notch. Whether it’s a routine check-up or a sick visit, we always leave feeling supported and confident in the care our children receive.

I’m so grateful to have found Delaware Modern Pediatrics 6years ago — they set the standard for what compassionate, modern pediatric care should be! Highly recommend to any parent looking for outstanding pediatricians who truly care.

Rated 5 out of 5 stars
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