Colonia
732-396-0700
Plainfield
908-757-8687
Kids Care Pediatrics
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Patient Portal
Kids Care Pediatrics
732-396-0700
Search
Appointments
Pay My Bill
Patient Portal
About Us
Welcome
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Prenatal Care
Well Child Visits
Sick Child Visits
Chronic Conditions
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Ear Piercing
Flu Vaccine Clinic
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Travel Clinic
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Expecting
Office Info
Appointments
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After Hours
New Patients
Resources
Immunization Schedule
Immunization Information
Parent Resources
Helpful Links
FAQs
Hospitals
Locations
About Us
Welcome
Our Mission
Our Providers
Reviews
Services
Prenatal Care
Well Child Visits
Sick Child Visits
Chronic Conditions
Diagnostics
Ear Piercing
Flu Vaccine Clinic
Mental Health
Nutritionists
Telehealth
Sports Physicals
Travel Clinic
Other Services
Expecting
Office Info
Appointments
Forms
Insurance & Billing
Policies
After Hours
New Patients
Resources
Immunization Schedule
Immunization Information
Parent Resources
Helpful Links
FAQs
Hospitals
Locations
Forms
All Your Patient Forms In One Place
The following forms are here so that you can download and fill out prior to your visit.
Annual Patient Packet Forms
eNGLISH
Adult Patient Registration (PDF)
Annual Consent and Acknowledgement (PDF)
Child Registration (PDF)
Notice of Privacy Practices (PDF)
Pediatric Family Registration (PDF)
Spanish
Aviso de Prácticas de Privacidad (PDF)
Consentimiento y Reconocimiento Anual (PDF)
Registro de Niños (PDF)
Registro de Pacientes Adultos (PDF)
Registro Familiar Pediátrico (PDF)
Patient Forms
18-year old: ADULTHOOD Letter (PDF)
ABN - Form Instructions
ABN – Advanced Beneficiary Notice of Noncoverage (Medicare only) (PDF)
Advocare Beyfortus Patient Liability Form
Authorization for Use & Disclosure of Protected Health Information (PHI) (PDF)
Authorization to Bring a Minor (PDF)
Cancellation of Prior Health Information Exchange (HIE): Opt-Out (PDF)
Cancellation of Prior SureScripts: Opt-Out (PDF)
Case Registration (PDF)
Estimated Cost: Out-of-Network Services (PDF)
Healow Trifold (PDF)
Health Information Exchange (HIE): FAQs (PDF)
Health Information Exchange (HIE): Opt-Out (PDF)
IMM Withdrawal from NJIIS
Informed Consent: In-Office Procedures (PDF)
Informed Consent: Surgical Procedure or Invasive Treatment Procedure (PDF)
New Jersey Immunization Information System (NJIIS): Consent (PDF)
Newborn Insurance Reminder (PDF)
Patient Consent to Draw/Test Blood (PDF)
Patient Financial Responsibility (PDF)
Patient Photograph/Video Information Release Authorization (PDF)
Patient Portal Proxy Authorization (Age 18+)
Patient Portal: FAQs (PDF)
Patient Portal: Flyer (PDF)
Patient Preventive Visit and Problem Visit Same Day Acknowledgement
Practice & Payment Philosophy (PDF)
Professional/Provider: Out-of-Network Disclosure Notification (PDF)
Request for Amendment to Protected Health Information
Restriction of Disclosure to Health Plan (PDF)
SureScripts: Opt-Out (PDF)
Vaccine Administration Record: Consent/Refusal to Vaccinate (PDF)
18-year old: ADULTHOOD Letter (PDF)
ABN - Form Instructions
ABN – Advanced Beneficiary Notice of Noncoverage (Medicare only) (PDF)
Advocare Beyfortus Patient Liability Form
Authorization for Use & Disclosure of Protected Health Information (PHI) (PDF)
Authorization to Bring a Minor (PDF)
Cancellation of Prior Health Information Exchange (HIE): Opt-Out (PDF)
Cancellation of Prior SureScripts: Opt-Out (PDF)
Case Registration (PDF)
Estimated Cost: Out-of-Network Services (PDF)
Healow Trifold (PDF)
Health Information Exchange (HIE): FAQs (PDF)
Health Information Exchange (HIE): Opt-Out (PDF)
IMM Withdrawal from NJIIS
Informed Consent: In-Office Procedures (PDF)
Informed Consent: Surgical Procedure or Invasive Treatment Procedure (PDF)
New Jersey Immunization Information System (NJIIS): Consent (PDF)
Newborn Insurance Reminder (PDF)
Patient Consent to Draw/Test Blood (PDF)
Patient Financial Responsibility (PDF)
Patient Photograph/Video Information Release Authorization (PDF)
Patient Portal Proxy Authorization (Age 18+)
Patient Portal: FAQs (PDF)
Patient Portal: Flyer (PDF)
Patient Preventive Visit and Problem Visit Same Day Acknowledgement
Practice & Payment Philosophy (PDF)
Professional/Provider: Out-of-Network Disclosure Notification (PDF)
Request for Amendment to Protected Health Information
Restriction of Disclosure to Health Plan (PDF)
SureScripts: Opt-Out (PDF)
Vaccine Administration Record: Consent/Refusal to Vaccinate (PDF)
Alternate Languages
ABN – Aviso Anticipado de No Cobertura Para el Beneficiario (Medicare Solamente) (PDF)
Advocare Newborn Insurance Reminder - SPANISH
Autorización para el uso y divulgación de información médica protegida (PHI) (PDF)
Autorización para traer a un menor de edad
Formulario de responsabilidad financiera del paciente de Advocare
Notice of Privacy Practices - Arabic
Notificación de divulgación a profesional/proveedor fuera de la red
Patient Preventative Visit and Problem Visit Same Day Acknowledgement Form - Spanish (PDF)
Recordatorio de Seguro Para Recién Nacidos (PDF)
Vaccine Consent - Spanish
Vaccine Consent - Turkish
ABN – Aviso Anticipado de No Cobertura Para el Beneficiario (Medicare Solamente) (PDF)
Advocare Newborn Insurance Reminder - SPANISH
Autorización para el uso y divulgación de información médica protegida (PHI) (PDF)
Autorización para traer a un menor de edad
Formulario de responsabilidad financiera del paciente de Advocare
Notice of Privacy Practices - Arabic
Notificación de divulgación a profesional/proveedor fuera de la red
Patient Preventative Visit and Problem Visit Same Day Acknowledgement Form - Spanish (PDF)
Recordatorio de Seguro Para Recién Nacidos (PDF)
Vaccine Consent - Spanish
Vaccine Consent - Turkish
Assessment Forms
Edinburgh Postnatal Depression Scale (PDF)
MCHAT, Revised Follow-Up: Checklist Only (PDF)
MCHAT, Revised Follow-Up: Packet with Checklist (PDF)
NICHQ Vanderbilt Assessment: Follow-Up (Parent) (PDF)
NICHQ Vanderbilt Assessment: Follow-Up (Teacher) (PDF)
NICHQ Vanderbilt Initial Assessment (Parent) (PDF)
NICHQ Vanderbilt Initial Assessment (Teacher) (PDF)
PSC-Y Report (PDF)
Required Forms
Advocare Non-Discrimination Notice (PDF)
Advocare Patients Bill of Rights (PDF)
Advocare Payer List (PDF)
Explanation of Individual's Right to Appeal Health Insurance Determinations (PDF)
Grievance Procedure – Spanish (PDF)
Grievance Procedure (PDF)
Non-Discrimination – Spanish (PDF)
Patient’s Bill of Rights – Spanish (PDF)
Right to an Observer – Spanish (PDF)
Right to an Observer (PDF)
