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.

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: 2019 Complete

Well Visit Forms click link below:

• Yearly Wellness and Physical Exam Paperwork (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

8,708 total views, 1 views today