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15-01 Broadway Suite# 36 FairLawn,NJ 07410 Tel:(201)773-6171Welcome to KidKare Medical P.A.
These forms are provided to help make your visit to our office as convenient for you as possible. If it is your first visit, please be sure to complete the Registration form, Patient History form and the Medical Release form.
Our forms are in Adobe format. You may download Adobe Reader for free at www.adobe.com.
Welcom Form
Please complete this form in its entirety before your first visit.
Registration Form
This helps us to collect all the demographic, financial responsibility, and legal information we need to properly set up your account.
Patient History Form
It is very important that you take the time to fill out this form before your first visit. Our physicians use this information to establish any areas of concern or issues that might need to be addressed.
Medical Records Release Form
If your children have previously been treated by other physicians or hospitals we ask that you complete this medical release and bring it with you to our office.
Financial Policy
Information sheet explaining how KidKare Medical treats financial issues.
HIPPA Privacy Policy
Information sheet regarding your rights as a patient as detailed in the Health Insurance Portability and Accountability Act.