Feel free to download, print, and fill out the following forms prior to your child's visit. Just bring them in at the time of your appointment and see the doctor even faster!

You will need the Adobe Acrobat Reader to view and print the forms. If you do not already have it you can download it for free

Patient Registration Form
Please complete one form per child.

Patient Insurance Information Form
Please complete one form per child.

Patient History Form
Please complete one form per child.

Authorization for Medical Treatment
Please complete one form per child.

Notice of Privacy
For review purposes only - You do not need to bring this form with you.

Notice of Privacy - Sign Off
Please print and sign this document verifying you have read our "Notice of Privacy" form. Please complete and sign one form per child.

Records Release Authorization Form
Please complete one form per child.

Financial Policy
Please print and sign this document verifying you have read our "Financial Policy" form. Please complete and sign one form per child.

Credit Card Authorization Form
Please print, complete and fax this document to our front desk at 718.836.2305 (Brooklyn office) or 718.982.6830 (Staten Island office). You may also fax this form directly to our Billing Department at 718.698.3730.

Nutrition Form
Please complete one form per child prior to your visit with the Nutritionist.

Records Release Authorization Form - Outgoing
Please complete one form per child to request records to be transferred.