For your convenience, the forms you’ll need for your first visit and for requesting health information are listed below.
New Patient Forms
If you are a new patient, please complete these forms and bring them to your first visit.
- New Patient Intake Form Adult
- Nuevo Paciente Formulario de Admisión Adulto
- New Patient Intake Form Pediatric
- General Patient Information Form
- Notice of Privacy Practices
- Aviso Sobre Las Prácticas de Privacidad
- Notice of Privacy Practices - Patient Acknowledgement
- Aviso Sobre Las Prácticas de Privacidad - Reconocimiento de Recibo
Authorization for Release of Health Information
If you would like us to release any of your health information to another party, you must fill out a written authorization.
Please complete the form above and return it by fax or mail to:
Medical Records Department
180 Fort Washington Ave., 7th Floor
New York, NY 10032