Patient Forms - Pediatrics
Patient Forms for Pediatrics
All forms are viewed through Adobe Acrobat Reader.
New Patient Form
Please fill in the New Patient Form online, print it out, and then bring it with you on your first visit to NMPG.
How to Request Medical Records:
In order to comply with new "Privacy" legislation, beginning January 2002, NMPG will charge our patients a processing fee for copying medical records. The fee will be $20.00 for the first 25 pages and $0.50 per page thereafter. The $20 advance fee and a signed Release of Medical Records form must be sent to your physician's office prior to processing. A check or money order is accepted for medical records. Check payment should be addressed to MD Copy Service. Thank you.
Click on the office you visit for the Medical Records Form: