Patients over the age of 18 must sign any release of health information forms themselves. There will be a fee for any records requested for personal use.
Forms
- Release of Health Information.
- Patient Registration & Yearly Update
- ASQ Developmental Questionnaire
- Child Health History
- Designation Form
- Third Party Form/Parental Authorization
- NYS Health Care Proxy Form (PDF).
Policies
- Summerwood Pediatrics Policies (PDF)
- HIPAA Notice Of Privacy Practices (PDF)
- Turning 18 Booklet For Patients And Parents (PDF)
2/22/21: It is now an office policy that if you need to obtain a form or document electronically, you must have an active patient portal for us to send it to you. If you do not currently have access to you child's portal, please call the office for details. Thank you!