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:

• 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): 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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