Patient Forms
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- Registration Form
- Acknowledgement of Electronic Submission of Prescriptions
- Patient Authorization For Use and Disclosure of Protected Health Information
- Release of Information and Release of Benefits
- Acknowledgement of Receipt of Notice of Privacy Practices
- Notice of Privacy Practices
- Initial History Questionnaire
Bard & Didriksen Pediatrics
2160 S. State Route 157, Suite B
Glen Carbon, Illinois 62034
Click here for driving directions.
Phone: (618) 692-1212
Fax: (618) 692-4875
After Hours Exchange:
(877) 552-1735
HOURS
(By Appointment Only)
Monday - Friday 8:30am to 5:00pm
Saturday* 8:30am to 12:00pm
(*Closed Saturdays Memorial Day-Labor Day)
Holiday Hours
Closed Memorial Day
Closed July 3rd & 4th
Closed Labor Day
Closed Thanksgiving
Open Friday After Thanksgiving
Closed Christmas and New Year's Day