Patient Forms

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.

General forms:

  • E-Mail Agreement [PDF]
  • 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]
  • Universal Child Health Record [PDF]

Developmental Milestone Forms:

  • SWYC 2 Months [PDF]
  • SWYC 4 Months [PDF]
  • SWYC 6 Months [PDF]
  • SWYC 9 Months [PDF]
  • SWYC 12 Months [PDF]
  • SWYC 15 Months [PDF]
  • SWYC 18 Months [PDF]
  • SWYC 24 Months [PDF]
  • SWYC 36 Months [PDF]
  • SWYC 48 Months [PDF]
  • SWYC 60 Months [PDF]

Behavioral Health Forms:

  • 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]
  • Pediatric Psychiatry Collaborative and Medical Release [PDF]
  • SCARED Child [PDF]
  • SCARED Parent [PDF]
  • CRAFT [PDF]
  • M-CHAT [PDF]
  • PSC Parent form (English and Spanish) [PDF]
  • Y-PSC Patient Form (English and Spanish) [PDF]


In order to view or print these forms you will need Adobe Acrobat Reader installed. Click here to download it: Get Adobe Reader

Hours of Operation

Our Regular Schedule

Sparta Office

Monday:

9:00 am-6:00 pm

Tuesday:

9:00 am-6:00 pm

Wednesday:

9:00 am-6:00 pm

Thursday:

9:00 am-7:00 pm

Friday:

9:00 am-5:00 pm

Saturday:

9:00 am-1:00 pm

Sunday:

9:30 am-12:00 pm

Milford Office

Monday:

9:30 am-5:00 pm

Tuesday:

1:00 pm-6:00 pm

Wednesday:

10:00 am-6:00 pm

Thursday:

9:30 am-5:00 pm

Friday:

9:30 am-5:00 pm

Saturday:

Closed

Sunday:

Closed

Our Locations

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