Skip to the content
  • Phone
  • Our Office
  • Appointments
  • Portal
Home

Stages Pediatrics Stages Pediatrics Home

(212) 923-5050 Request Appointment Patient Portal

Primary Menu

  • Home
  • About Us
    • Who We Are
    • Our Staff
    • Parent Reviews
    • News & Events
  • Our Office
  • Parent Information
    • Your Visit: FAQs
    • Billing & Insurance
    • Parent Resources
    • Child Health Library
    • Patient Portal
  • Forms & Policies
  • Pediatric Services
    • Overview
    • Allergies
    • Children/Teen Health Care
    • Infant Health Care
    • Respiratory Issues
Forms & Policies

Forms & Policies

Save time: Download Patient Forms before coming (Baje Sus Formularios y Llénelos antes de Venir)

Before your appointment with us, quickly and conveniently access patient forms from our practice.

To view the forms listed below, you will need to download Adobe Reader. Please bring your completed forms with you to our office at the time of your visit.

New Patients

  • New Patient Form – English
  • New Patient Form – Spanish

Office Policies

  • Office Policy
  • Medical Release Authorization (English)
  • Out of Pocket Fee Schedule
  • Immunization Policy (English)
  • Terminos para Vacunar (Spanish)

 

Forms

  • Sports Physical Form
  • Change Formula Form
  • School Physical Form
  • Asthma Treatment Form
  • ADHD Evaluation Form for Parents
  • ADHD Evaluation Form for Teachers

 

Miscellaneous

  • ER/Hospitalizations Follow up  Consent Form
  • Consentimiento Para Seguir Visitas al Hospital
  • Circle of Care
  • Círculo de Cuidado
  • Locate a Head Start Programs

In This Section

  • Your Visit: FAQs
  • Forms & Policies
  • Billing & Insurance
  • Parent Resources
  • Child Health Library
  • Patient Portal
  • Appointment Request

Where We’re Located


128 Fort Washington Avenue #1J
New York, NY 10032

Phone: (212) 923-5050

NCQA Recognition

Connect with Us


   

  • Home
  • About Us
  • Our Office
  • Parent Information
  • Forms & Policies
  • Pediatric Services
  • Privacy Policy
  • Notice of Non-Discrimination

Copyright 2023 Stages Pediatrics | Managed by Practis | Search