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Forms
The following are forms useful for new patients and current patients alike. If you'd like to save time in the office or prefer to fill out the forms at your leisure, you can now just download and print. Unable to print the forms? No problem, we also have all forms available in the office.
Please download our demographic sheet if your child is a new patient or if your child is a current patient and there have been any changes to your contact information or insurance since your child's last visit. If all the information is the same for your other children, feel free to list their names and dates of birth on the form as well (rather than filling out separate forms).
Practice consent forms must be completed for all patients. Please download, read, and sign these documents if you have not done so in the current year.
A Family Medical History form must be completed for each new patient.
A BCBS Insurance Waiver is required for any child with a BCBS or BCBS affiliated insurance plan.
The M-Chat is an early childhood screening for autism in toddlers. If your child is due for a well exam any time between the ages of 18 months and 2 years you will be asked to fill out a screen. Find out more at www.m-chat.org
The Teen Screen program, started at Columbia University, is used to screen adolescents for anxiety, depression, ADD, and ADHD. All patients 11 years of age and older scheduled for a well visit (school physical) are asked to complete this confidential questionnaire on their own. Parents or teens may choose to decline this screening.
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