208 Delaware Avenue, Delmar, NY 12054 (518) 439-5611 Patient Portal Login

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Forms & Docs

To provide your family with the best service, we have some policies to ensure things run smoothly

New patient paperwork

Before your first visit

Patient Information

Contact, insurance, and demographic details we keep on file.

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Past Medical History

Your child’s own conditions, allergies, surgeries, and current medications.

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Family & Birth History

Family medical history and details about your child’s birth.

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HIPAA Consent

Consent for us to use and share health information to coordinate care.

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Policies & authorizations

Policies & authorizations

Cancellation & No-Show Policy

Our appointment policy and the $50 no-show fee. Please review and sign.

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Third-Party Records Release

Authorize us to share records with a school, provider, or family member.

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Young Adult Care & Transition

For patients turning 18: staying with us or transitioning to adult care.

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Prefer paper? Printed copies are available at the front desk. Questions about any form? Call us at (518) 439-5611.