Patient Forms - Burnt Hills Pediatrics and Internal Medicine

Patient Forms

Below you can find the forms you will need for your visit. Please select the correct forms based on your appointment type.

If you complete these forms prior to your appointment, please fax them to (518) 477-5182 or mail them at least 5 days before your appointment. Otherwise, you can complete these forms and bring them with you to the office when you come for your appointment.

All forms are in Adobe PDF format.

Adolescent Packet
Annual Intake Packet
Medicare Wellness Visit
New Patient Packet
Pediatric History — Yearly Update