Camillus: (315) 487-1541
Liverpool: (315) 652-1070

New Patient Forms

***FALL 2017–Our office is temporarily only accepting new patients less than five years of age and prenatal visits, and not accepting patients older than six years of age, so we have more time to accommodate our current patients.  We are looking forward to welcoming new patients again soon!***


As a new patient at Pediatric Associates, it will be helpful if you download and complete the following three forms and bring to the office for your first visit.

  1. Child Registration Form (PDF)
  2. Child History Record (PDF)
  3. Release of Information Authorization Form (PDF)
Website Design by Koenig Advertising Public Relations Web Design Syracuse