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Forms & Policies
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Forms & Policies

For your convenience, the forms below are available for our new patients to download and complete to expedite your first appointment with Dr. Jerome. Just download and print the new patient forms packet (see below). Complete the new patient form packet at a time convenient for you. Bring the complete forms along with your insurance information and a valid ID to your first appointment.

Download our practice form packets

North Manhattan Pediatrics' new patient form packet. Completing this registration form prior to your child's scheduled appointment will decrease your wait time and expedite your visit at your pediatrician's office.

Download our pricavy policy

North Manhattan Pediatrics' privacy policy. We ask you to read and sign a Privacy Notice. To save you time in the office, please read and sign this document. Bring only the signed page in your packet with you to your appointment.

Download our health form policy.

North Manhattan Pediatrics' health form policy. It is our goal to complete Health Forms as quickly as possible - with your cooperation. We would like you to be aware of our policies.

Download our vaccination policy

North Manhattan Pediatrics' vaccination policy.  As medical professionals, we feel very strongly that vaccinating children on schedule with currently available vaccines is absolutely the right thing to do for all children and young adults. Please read this policy, and feel free to discuss any questions or concerns you may have about vaccines with any one of us. 

Download our appointment policy

North Manhattan Pediatrics' appointment policy. Your appointment time is reserved exclusively for you and your Child.  Please read our policy about cancellations, missed appoinments and rescheduling an appointment.