Welcome to the Broadway Pediatric Associates
For new patients there is information about our practice which can be printed out and brought with you at your first visit.
For our established patients there are copies of forms for a variety of situations including school physicals. Preprinting some of these may be helpful.
Bear in mind that we give you a copy of your childs Universal Child Health Care Record or part B of the Athletic Pre-Participation Physical Examination Form which have been preprinted with much of your information, at every physical exam.
Information for New and Prospective Patients is outlined below.
- Practice Brochure
- HIPAA Privacy Notice
- Your Health Plan Coverage and Our Financial Policies
- BCD Financial Policies Page
Prior to your first visit, we would like you to complete new patient forms so that we may obtain all previous records you or your child may have.
Should you have any questions about this process, please contact our office manager Linda at 201-664-7444. It would be helpful if you downloaded and filled out the Record Request form.
The new patient packet includes the following information. Please print out and complete these forms prior to arrival
- Family Information Sheet
- Insurance Information Form
- Financial Policy Acknowledgement Form and Waiver **
- HIPAA Policy Acknowledgement Form
** Please do not sign this form until you have read all the sections of the Financial Policy above.
- Universal Child Health Care Record
Provided for Grades K through 5 .
- Athletic Pre-Participation Physical Examination
Please print out this form and complete the History (Page 1, complete page 2 for children with disabilities) before you bring your child for a physical exam. (6th grade and older) Pages 3 and 4 will be provided.
- New York Health Certificate and Appraisal
Most NYS schools accept the NJ form, but you may bring this if yours does not. Please prefill demographic information