Our practice is committed to improving the lives of the children we serve by providing compassionate, high quality medical care in a child-centered environment.
To fulfill this mission, we are committed to:
- Listening to our young patients and their families who we are privileged to serve.
- Guiding our patients along a path of optimal health and wellness.
- Continually pursuing excellence at all levels through continuing education.
If you're preparing for your child's first visit, you can do a few things to help expedite the appointment. Please provide the following information when you arrive for your visit:
- Insurance cards
- Complete immunization records
- Medical records from your previous pediatrician
We are happy to provide our office forms for convenient download on your home computer. Please print and complete the forms below, and bring them with you to your child's first appointment. Questions about which forms you need? Please call our office and our courteous staff will assist you in preparing for your child's first visit.
- Child Registration Packet [PDF]
- Adult Registration Packet [PDF]
- Authorization for Release of Information [PDF]
- Authorization to Bring a Minor [PDF]
- Newborn Insurance Reminder [PDF]
- HIPAA Acknowledgement & Release Form [PDF]
- Consent for Treatment, Payment and Healthcare Operations [PDF]
- Request to Copy Protected Health Information [PDF]
- Authorization to Use or Disclosure PHI [PDF]
- New Jersey Immunization Information System (NJIIS) [PDF]
- 18 Year Old Letter [PDF]
- Adult Registration Form [PDF]
- Child/Dependent Registration Form [PDF]
- Pediatric Family Registration Form [PDF]
- Notice of Privacy Practices [PDF]
- Vaccine Policy and Consent [PDF]
- Athletic Physicals Form [PDF]
- NICHQ Vanderbilt Assessment Scale Teacher Informant [PDF]
- NICHQ Vanderbilt Assessment Scale Parent Informant [PDF]
- NICHQ Vanderbilt Assessment Follow-up Teacher Informant [PDF]
- NICHQ Vanderbilt Assessment Follow-up Parent Informant [PDF]
- Vanderbilt ADHD Diagnostic Teacher Rating Scale [PDF]
- Vanderbilt ADHD Diagnostic Parent Rating Scale [PDF]
- Universal Child Health Record [PDF]
In order to view or print these forms you will need Adobe Acrobat Reader installed. Click here to download it:
The Initial Visit
Our compassionate pediatricians do whatever it takes to make every visit to our office a pleasant, relaxed experience. With all of the important information about our practice available on our website, you can feel confident that you and child are well-prepared for your first appointment. We also invite you to review our doctors in order to get to know our doctors and staff. We look forward to meeting you.