To save time at your visit, we strongly encourage all patients to print and bring their filled out forms to the appointment.

You may fax the form to us at 518-383-3255 if that works best.

Please note that all forms that require a signature must be hand signed, we will not accept a typed or digital signature.

Flu Vaccine Screening Form Click Here Please complete prior to arrival

Registration Forms (this includes most of the items below, so you can print the entire set at one time)

• Complete Registration Packet (New Patient Paperwork) – click this link: Complete Packet Updated 2019

Well Visit Forms click link below:

• Well Physical Exam Forms – Save time and fill out the night before (sorted by age)

ADHD Forms click below:

• ADHD Forms (please note that we require return of these forms BEFORE we will schedule your appointment)

Consent and Record Release forms:

• Release for records going to our office (transferring in): 2018 records incoming
• Release for records leaving our office (transferring out): 2019 records outgoing
• Release for medical information to be emailed or faxed (to send individual items to other locations): 2018 PHI disclosure form
• 18 year old patient consent to speak to others (so we can talk to parents about the patient): 2018 18yr old patient consent

Updated information:

• Address change or update (please review closely): 2018 address change
• Insurance change or update (please review closely): 2018 insurance change

Other Forms:

• Pediatric History Questionnaire (required for each patient individually)2018 PHQ
• Healthcare Parental Proxy form (for another adult to bring your child into the office for a visit, please read closely)2018 proxy
• Race and Ethnicity form (Federally required to be asked to all patients)2018 r and e form
• Office Policies and Consent for treatment (for review, please ask if you want your signed copy on file)2018 policies and consent

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