Patient forms
Uptown Pediatrics patient forms
Every form you might need, in one place. Download, print, and fill them out before your visit to save time in the office.
Registration, consent & records
- New Patient RegistrationComplete before your first visit. (PDF)
- Financial PolicyPlease review and sign. (PDF)
- Consent to Treat Without Parent PresentFor visits with a nanny, grandparent, or other caregiver. (PDF)
- Request for Copy of Medical RecordsRequest your child's chart. (PDF)
- Teen Confidentiality AgreementReview together before adolescent visits. (PDF)
- Prenatal Visit FormFor expecting parents meeting the practice. (PDF)
- Notice of Privacy PracticesHow we protect your family's health information. (PDF)
Psychiatry forms
For a first visit with Dr. Hoon. Complete the intake packet before your appointment.
How to return completed forms
Bring them in
Hand them to the front desk at 1245 Park Avenue (entrance on 96th Street).
Fax them
Fax to 212-534-1086, then call 212-427-0540 if you'd like us to confirm we got them.
Upload in the portal
Existing patients can upload forms, including school, camp, and sports forms, through the patient portal.
Please don't email forms with health information. The portal, fax, and front desk keep them private.
Ready to join the Uptown Pediatrics family?
We welcome new patients from newborns to teens.
New to Uptown Pediatrics
Email us to become a patient
Tell us your child's age and insurance, and we'll get back to you to set up a first visit.
Email ushello@upnyc.pcc.com · Please leave out symptoms and medical details.
Already a patient
Message us in the patient portal
Send us a message to set up a checkup or follow-up, or to ask your doctor a question. You can also see records there.
Message usSick today? Call for a same-day appointment, or just stop by weekdays 9:30-3.
Prefer to talk? Call us at 212-427-0540