Forms & Policies

Online Forms & Services

• Register Online – Patient Education Series
• Register Online – Open House Registration
• Referral Request
• International Travel Consultation Form
• Prescription Refill
• Pay Your Bill
• Join Our Mailing List

Download Forms

You may download and print any of our forms listed below before coming to our office. This will get you out of the waiting room and in to see the doctor a lot quicker! You may either bring them with you to the first visit, or if you wish, fax them to us before your appointment.

You may download Adobe Reader for free at adobe.com.

• Patient Registration Form
• Pre-Visit Questionnaire – 1mo-30mo
• Pre-Visit Questionnaire – 3yr-10yr
• Pre-Visit Questionnaire – 11yr and older
• Sickle Cell Newborn Screen Release Form
• COVID Vaccine Screening Form
• Permission to Access Adult Patients Via Portal
• HIPAA Privacy Authorization Form
• PNP Health History Form Required With All Form Submissions
• PNP Asthma and Allergy Questionnaire
• Physical Exam Reminder Contact Preference Form
• Authorization for Release of Medical Records
• Universal Health Form ( Daycare, Preschool, Up to Grade 5)
• Athletic Pre-Participation Physical Exam Form ( Grades 6 and up)
• Asthma Action Plan
• Food Allergy Action Plan
• Parental Consent Form
• Vanderbilt Form – Parent, Initial
• Vanderbilt Form – Teacher, Initial
• Vanderbilt Form – Parent, Follow-up
• Vanderbilt Form – Teacher, Follow-up
• Screen for Child Anxiety Related Disorders (SCARED)

Policies

• Notice of Privacy Practices
• Financial Policy
• Policy Regarding Presence of Parents
• Princeton Nassau Pediatrics’ Vaccine Policy Statement

Appointments

All patients are seen by appointment. When you call, tell the receptionist the reason for your appointment and any other information that will help us decide how much time to allow for the visit. If you must cancel an appointment, please give us 24 hours notice so that we may offer the time to someone else. Evening hours are available for emergent visits at the Princeton office. We staff the Princeton office on weekend and holiday mornings for sick patients who should not wait to be seen until the next day.

During office hours, a receptionist or a pediatric nurse will answer your call. State the reason for your call. If you have medical questions, the nurse often has the answers. If not, she will transfer your questions to your pediatrician. Each doctor blocks out a portion of the day to return phone calls. If you will be away from your phone, please provide us with times you will be available so the doctor can reach you.

If you need an appointment on the same day, you may call after 8:00 AM, or after 8:30 AM on Sunday. No advance appointments are made for Sundays, when we see only patients who should not wait a day to be seen. If you have a non-urgent medical question, wish to make a future appointment, or have a business question, please call between 8:00 am and 5:00 pm, Monday through Friday. The appointment desk is closed from 1:00 pm to 2:00 pm, but there is an emergency number given on the tape during that time for urgent calls.

For medical emergencies, call us anytime. During office hours, our staff will assist you in making arrangements to see a doctor immediately. After hours, our calls are transferred to the Triage Logic call center directly. Your call will be answered by a pediatric nurse who can assist you or put you in contact with the pediatrician on-call in minutes. Unfortunately, any office or answering service can be overly busy and occasionally make mistakes. If your urgent call is not returned quickly, repeat your call. On the other hand, please do not call about routine matters after office hours.

We recognize that urgent problems must be seen immediately, but even these situations we ask that you call ahead before leaving for our office. This helps us determine whether your child is contagious and may be a danger to other children in the waiting rooms, whether we need to free-up a specific treatment room, how much time we should allot for your visit, and whether we need to shift other appointments to make room for your child. For all scheduled visits, the choice of doctor is up to you.

For urgent visits during office hours, your preference is respected whenever possible. After hours, the doctor on-call will handle all emergency situations.