MDs4kids--a div of Allied Pediatrics of New York, PLLC -- New patient intake forms

Dear Parents:

Welcome to our practice. In order to facilitate your first visit to our office, we have placed our "intake" paperwork on this website (see below) so that you may review and sign our office policy and complete the insurance paperwork before your first visit. Please bring this paperwork with you when you come to the office along with your insurance card.

If you are already in our practice and have a change in your medical insurance coverage, a change of address or phone number, please download a new intake form and update this information.

If you would like us to release any of your protected health information to another physician, school, etc., you will need to complete an authorization form. These forms may be downloaded (see below) or we will provide a copy to you at our office.

If you choose to use email to contact our office, you will need to complete an "Agreement on Use of Email" and transmit that to us as well. If you would like to use a more secure, HIPAA-compliant email method that does not require this agreement, please click here.

Please let us know if you have any questions. You may contact our office manager at 516 466-5437, ext. 107, or by email manager@MDs4kids.com to discuss any questions you may have.

NEWBORN, NEW PATIENT, NEW INSURANCE INTAKE FORMS