The Mall Office
84 Highland Ave
Salem, MA 01970

 
(978) 745-3050
(978) 745-7014 (fax)
Office Hours | Map

Ayres D'Souza Medical Building
30 Tozer Rd
Beverly, MA 01915

(978) 745-3050
(978) 745-7014 (fax)
Office Hours | Map

Forms

Before your appointment with us, quickly and conveniently access patient forms from our practice.

Download Patient Forms

Get Adobe AcrobatTo view the forms listed below, you will need Adobe Reader. You may download Adobe Reader for free at www.adobe.com. Please bring your completed forms with you to our office at the time of your visit.

(Please complete and return to the office)

Medical Records

Paperwork for Newborns and New Patients

Well Visit / Physical Paperwork

For Patients 18, 24 and 30 months old
Needed at every Physical for all patients 4 to 15 years of age
Necesario para todos los pacientes en cada Físico de 4 a 15 años de edad
Needed at every Physical for all patients 16 years and older
Necesario para todos los pacientes en cada Físico de 16 años en adelante
For Patients 18 years and older
Needed at every Physical for ALL patients

PAGS News

Due to the storm, both our Beverly and Salem Offices will be closed.  All scheduled appointment will be rescheduled.  We can be reached by phone for any urgent questions or concerns. 
Even though it feels like Spring, the cold & flu season is still hanging on.  As as result, we are experiencing higher than normal call volume.  We will return your call as soon as possible, but they will be answered in order of medical necessity.  Thank you for your understanding.
Congratulations to Dr. Campbell, Dr. D'Souza, Dr. Jalali and Dr. Mandell for being voted top pediatricans in Northshore Magazine (March 2017).  We have a great team at PAGS!

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