Forms to bring
Welcome to the Division of General Pediatrics at Cohen Children’s. For your convenience, the following forms are available to download and complete before your office visit.
New patient forms (for first visit only)
New patients can save time during their first appointment by completing the Patient Registration form prior to their visit. Please print and fill out all applicable forms and present them to the front desk when you arrive for your first office visit. This initial history questionnaire must be filled out for all new patients.
Help us coordinate your care (after first visit)
This form helps us update your child’s records and address any questions or concerns you may have.
FollowMyHealth patient portal access for a minor patient (under 13)
If you are the parent or legal guardian of a Northwell Health Physician Partners patient who is under the age of 13, you can complete this form to request “proxy access” to your child’s health information in the FollowMyHealth Patient Portal. Proxy access enables you to view some of your child’s health information in the portal and, in some instances, communicate through the portal with your child’s health care team. When your child turns 13, you will no longer be able to view any new information about your child in the portal. You must complete a separate form for each child for whom you are requesting proxy access.
Annual update form
Every year we will review the information we have on file for your child’s care. Please print and complete the form below.