Office Forms & Policies
All requests will be processed in 2-3 days. Please call the office at (212) 874-4500 if you are requesting a same day appointment.
You may download and print any of our forms listed below before coming to our office. This will get you out of the waiting room and in to see the doctor a lot quicker! You may either bring them with you to the first visit, or if you wish, fax them to us before your appointment.
You may download Adobe Reader for free at www.adobe.com.
- New Patient Registration
- HIPAA Consent and Medical Release Form (for patients 18 years and older)
- Annual Practice Fee (APF) Information Sheet
- Annual Practice Fee (APF)
- Vaccine Consent Form in Absence of Parent/Guardian
- Parent or Caregiver Flu/Covid Vaccination Registration Form
- Release of Medical Records
Insurance Information
We participate with most local and many national insurance plans. However, it is your responsibility to understand whether your insurance has limits on the doctors you can see, or the services you can receive.
If you provide complete and accurate information about your insurance, we will submit claims to your insurance carrier and receive payments for services. Depending on your insurance coverage, you may be responsible for co-payments, co-insurance, or other deductible amounts.
Form Policy
Our online patient portal offers a convenient way to submit your health forms. Please complete and upload your forms through the patient portal.
There is a $15 administrative fee for all camp and school forms to be completed within 7-10 business days.
A $35 administrative fee will be charged for all expedited forms. Expedited forms will be completed within 1-2 business days.
Completed forms may be downloaded from your child’s portal or picked up at the front desk. If you need a form mailed to you, please provide us with a self-addressed stamped envelope.
WESTSIDE PEDIATRICS ANNUAL PRACTICE FEE (APF)
May 2025-April 2026 APF
Greetings from your team at Westside Pediatrics!
As we look forward to our 29th(!) year, we at Westside Pediatrics remain committed to providing your children with the highest level of care. We continue to be an independent practice that accepts most insurance plans, and are confident that our practice model remains the best way for us to provide outstanding, personalized, accessible care for your family. Our Annual Practice Fee (APF) is essential in maintaining this model.
We respect that everyone’s health care costs come at a significant expense. Our Annual Practice Fee (APF) will not increase in 2025 and continues to be capped for families of three or more. The May 2025 through April 2026 APF will remain $350 per patient, with a family maximum of $850. This is due in the month of May. The APF is waived for the first 12 months of life, and is not automatically charged to your credit card on file. Please click here to pay your APF.
We remain honored and thankful for our trusted relationships and the opportunity to care for your family.
If you feel this fee represents an undue burden, please contact our office administrator at APF@wppc.pcc.com.
The information sheet provides further details regarding our Annual Practice Fee.
If you have further questions regarding our Annual Practice Fee, please contact us via email at APF@wppc.pcc.com.