Forms
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: Registration Packet v2019
Well Visit Forms click link below:
ADHD Forms click below:
Consent and Record Release forms:
- Release for records going to our office (transferring in): Records release incoming v2018
- Release for records leaving our office (transferring out): Records release outgoing v2019
- Release for medical information to be emailed or faxed (to send individual items to other locations such as your school): PHI disclosure form
- 18 year old patient consent to speak to others (so we can talk to parents about the patient): 18 year old patient consent v2018
Updated information:
- Address change or update (please review closely): Address change v2018
- Insurance change or update (please review closely): Insurance change v2018
Other Forms:
- Pediatric History Questionnaire (required for each patient individually) History Questionnaire v2018
- Healthcare Parental Proxy form (for another adult to bring your child into the office for a visit, please read closely) Proxy Form v2018
- Race and Ethnicity form (Federally required to be asked to all patients) Race and Ethnicity Form v2018
- Office Policies and Consent for treatment (for review, please ask if you want your signed copy on file) Policies and consent form v2018
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