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, our office at 30 Tozer Road will be closed on Monday. Our Salem office at 84 Highland Ave will be open from 8am - 12 pm for Urgent Care appointments.
Due to the storm, our Beverly office at 30 Tozer Road will be closed on Thursday.  Our office in Salem at 84 Highland Ave. will be open.
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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