Patient Forms

Prior to your first visit, please complete the Information Sheet, Financial Information and the Privacy Policy.

After you click the link, a browser window will open. You can either fill the form in on your computer and print it or print the form and fill it in by hand.

The completed forms can either be saved and uploaded to MyKids chart patient portal, faxed to (212) 874-9046 or scanned and emailed to

Please request your medical records be sent to our office prior to your 1st visit, we will need to review a copy of your child's medical records.

Key Forms

Download PDF
Flu COVID Questionnaire*
Patient Form*
18 and Older - Patient Form*
Patient Registration for Flu*
Vaccine Consent Form in Absence of Parent/Guardian*
Release of Records Form*
Lactation/Edinburgh Information Sheet*
Notice of Privacy Practices*

*You must have an Acrobat Reader to view the Acrobat files. If you don't already have Adobe Acrobat, you can download the Acrobat Reader Free.