Please call our office at (954) 423-2300 or (954) 384-8885 to register your child with our practice BEFORE completing the forms below. Our office will assist you with the process of transferring to our practice. Click here for more information about joining our practice.
In order to provide the most comprehensive care, it is important we have awareness of your child's previous care including but not limited to a complete immunization record. A Record Release Authorization is included in the New Patient Registration Forms, which will allow us to obtain your child's records prior to your first visit. If your child is currently under the care of a specialist, you may be asked to sign a Record Release Authorization for Specialist Physician.
Once you have registered your child as a new patient, you may complete your forms through our secure on-line website or use the print option to print and complete your forms.
For your first visit we ask that you arrive 15 minutes prior to your scheduled appointment, to allow us time to review your information. Upon your arrival to our office, you will need to provide us with your government issued ID, and your current insurance card.
On-line Option
To complete your forms on-line, click the link below. All forms must be completed.
Print Option
To print your forms, click the link below. E-mail your completed forms to [email protected] or fax to (954) 424-4200 (Please use bold print for the All forms must be completed.