Forms - Gramercy Pediatrics
There is a standard service charge of $15 for any form completion ($50 for expedited service – same/next business day if the physician is in the office). This amount is due at the time the forms are submitted to our office. Please allow 5-7 business days for processing. The forms will be sent to you in a password protected PDF with a six digit numerical code (no slashes). For example- if your child’s date of birth is January 15, 2003 the code will be 012003.
Delegation of Consent Form
> Download as a Word Doc
> Download as a PDF
Medical Records Release Form
If you are new to us (PDF)
If you need us to send your info elsewhere (PDF)