Print and complete the appropriate forms prior to your child's visit.
Some forms may not yet be availabe as PDFs to download and print
at home; they will be available in the office.

For our new patients

• Schedule of Routine Visits and Immunizations
• Patient Identification Form
• Initial History Questionnaire
• Notice of Privacy Practices
• NYC Vaccines for Children Eligibility Form
• Insurance Visit Schedule Notice (if you have Aetna, United Healthcare or Blue Cross Blue Shield)
• Fee Schedule

For subsequent routine visits

• Interval History Questionnaires
• Tuberculosis Exposure Questionnaire (at 6 mo, 12 mo, and yearly)
• Lead Risk Assessment Questionnaire
• M-CHAT (18 mo visit only)
• Adolescent/Young Adult Questionnaire (14 yo and older)
• Sports Clearance Questionnaire (for patients who require sports clearance forms)

For specific appointments

• Influenza Vaccine Questionnaire (for "Flu Vaccine Only" appointments)

Other forms

• Authorization for Release of Medical Records