Pediatric Associates
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New Patient Forms

FORMS TO BRING WITH YOU ON YOUR FIRST OFFICE VISIT

New Patient Forms


​As a new patient at Pediatric Associates, it will be helpful if you download and complete the following forms and bring to the office for your first visit.
Child Registration
Child History
Health Info Release

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Camillus, NY


​270 Township Boulevard
Camillus, NY 13031 (map)
Tel: (315) 487-1541
Fax: (315) 870–3893


Liverpool, NY


8086 Oswego Rd
​Liverpool NY 13090 (map)
Tel: (315) 652-1070
Fax: (315) 652–4679

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Recognized NCQA Patient-Centered Medical Home
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  • About Us
    • Our Team
    • Our History
    • Practice News
    • Careers
  • Contact Us
  • Portal & Bill Pay
  • Services
  • Parent Information
    • COVID-19 Test Sites
    • Flu Vaccine Info
    • Helpful Resources
    • Immunization Policy
    • Insurance & Payments
    • New Patient Forms
    • Newsletter Signup
    • Office Handouts
    • Online Requests
  • Patient-Centered Medical Home