Downloadable Forms
When you first plan on coming to our office, to save you time the day of your appointment, you may download, print and complete the forms to bring with you. All of the forms are in Adobe PDF file format.
CURRENT PATIENT INFORMATION
You will need to fill this form out if:
-you are new to the practice
-your address has changed
-your insurance information has changed since the last visit
-you have not been to the practice in a year
-any of your employment information changes
-updates/requirements in federal/state law
***Please bring your Photo ID, completed form and your insurance card with you to the visit
FINANCIAL POLICY AGREEMENT
You will need to fill this form out if:
-you are new to the practice
-you have not been to the practice in a year
-updates/requirements in federal/state law
SKYLANDS PEDIATRICS NOTICE OF PRIVACY PRACTICES (HIPAA)
We are required by applicable federal and state law to maintain the privacy of your health information. We are also required to give you this notice about our privacy practices, legal duties, and your rights concerning your health information. Please read the notice prior to your first visit to our office, or you may obtain a copy from our front desk.
MEDICAL RECORDS RELEASE FORM
Download, fill out and send to transfer your records to one of our three office locations, prior to your child's next appointment.
PARENTAL AUTHORIZATION TO TREAT MINOR CHILD
This form must be completed by the parent or legal guardian prior to a child under the age 18 being seen by the physicians, if not accompanied by the parent or legal guardian (ie grandparent).
AUTHORIZTION TO DISCLOSE HEALTH INFORMATION
This is a HIPAA requirement for patients older than 18 years of age, if you would like your parents or other legal guardians to discuss or obtain information regarding your healthcare.
ADOLESCENT MEDICAL HISTORY FORM
We highly recommend that you print and have your teenager complete this form prior to the well exam.
UNIVERSAL CHILD HEALTH RECORD
Use if needed for WIC, Early Intervention Programs, or other requirements for preschool or daycare.
NJDOE ANNUAL ATHLETIC PREPARTICIPATION PHYSICAL EXAM FORM
Download and fill out part "A" (parent section)-this MUST be filled out prior to the physicians filling out part "B".
ADHD TEACHER SCALE RATING FORM
Please have these filled out and with you on the day of your appointment.
