For your convenience, please print and fill out all applicable forms and present them to the front desk when you arrive for your office visit.

• Adult New Patient Intake Form
• Formulario de Admisión de Pacientes Adultos Nuevos
• Pediatric New Patient Intake Form
• Formulario de Admisión de Pacientes Nuevos de Pediatría
• Preoperative Screening Tool
• Notice of Privacy Practices

Medical Records

To request your medical record, please complete the Authorization to Release Medical Information Form / Autorización para Divulgar el Formulario de Información Médicos and fax the completed form to (212) 305-0116.

Learn more about HIPAA patient privacy information.