REGISTRATION FORMS

Choose the form/s appropriate for your visit.

Fill the form/s out on-line, print the form/s out, sign and bring them with you at the time of your visit; sorry, we cannot accept emailed forms.

Or we can provide you with hard copies of the necessary forms to be completed at the time of your visit.

First Visit Forms (PDF format)

1. Newborn to 2 years of age
   

2. 2+ Years of age
   

3. Please fill out the appropriate forms from above, print them out, and bring them with you for your visit to Dr. Rothman's office.
   

Returning Patient Form (PDF format)

1. Returning Patients, all ages
   

2. Please fill out the form, print it out, and bring it with you for your visit to Dr. Rothman's office.
   

Authorization for a Care-Taker (PDF format)

1. Caretaker Authorization Form
   

2. Please fill out the form, print it out, and bring it with you for your visit to Dr. Rothman's office.