Serving Bergen, Passaic & Hudson Counties · Est. 1976

We strive to provide compassionate care and comfort to our patients and their families.
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Expecting a baby?
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Schedule Sick Visit
​Schedule a Checkup for Ages 3+
Expecting a baby?

Patient Forms

For your convenience, please see the patient forms available for download below...

Thank you for choosing Tenafly Pediatrics as your pediatric health provider. 
Simply download and fill out the appropriate form(s) and hand deliver them to your primary office location. 
Note: These are PDF files, you may need to download Adobe Acrobat Reader to view them. 

Patient Registration Form

This is very helpful to complete prior
to coming in the first time

Download Form

Financial Policy Form

This must be signed by all new AND existing patients 

Download Form

Notice of Privacy Policy

Learn how we use, share, and protect our patient’s protected health information

Download Form

HIPAA Authorization Form

Federal law prevents us from sharing information with you about your child age 18 or older without their permission.  Please have them sign this form when they turn 18 to grant us permission to keep sharing their information with you.

Download Form

Transfer Form

Complete this form if you are transferring to us from another pediatric practice

Download Form

Vanderbilt Questionnaire

Provided by the National Institute for Children’s Health Quality.
Used for diagnosing ADHD

Download Form

Sports Physical Form

Download Form

Note: Emailed forms will be returned in 24-48 hours via our patient portal.

Universal Health Record Form

Download Form

Note: Emailed forms will be returned in 24-48 hours via our patient portal.

Do you have a form that needs to be completed by the doctor/staff?
You can email it to your primary office directly!

Some quick guidelines…

  • You must complete your part of the form (child’s name, date of birth on all pages) prior to emailing it to us. 
  • Please scan and send the form as an attachment, preferably PDF format, rather than just embodied in the email. If sending a picture of a form, it must be very clear and sent as an attachment.
  • If it is a Pre-participation Sports Form please include History page with all questions answered by the parent with any “yes” answers explained in the bottom right hand box.
  • Please allow 24-48 hours for completion — the completed forms will be uploaded into your child’s patient portal for your retrieval
  • Only use the email addresses below for forms, not for appointment requests. 
  • Following these guidelines allows us to do our part and process the form efficiently.

Tenafly: 
tenafly@tenaflypediatrics.com
Fort Lee:
fortlee@tenaflypediatrics.com
Clifton: 
clifton@tenaflypediatrics.com
Paramus: 
paramus@tenaflypediatrics.com
Oakland: 
oakland@tenaflypediatrics.com
Park Ridge: 
parkridge@tenaflypediatrics.com
Hoboken: 
hoboken@tenaflypediatrics.com
Teaneck: 
teaneck@tenaflypediatrics.com
Closter:
closter@tenaflypediatrics.com
Glen Rock:
glenrock@tenaflypediatrics.com

Note: We will be uploading completed forms (we need 24-48 hours to complete them) to your child’s patient portal, which is the most secure way, and it ensures you can access them at any time and will not go to a “spam” inbox.