Patient Forms

    All your paperwork in one place.

    Medical Record Request Form

    To obtain medical records from PM Pediatric Care please follow the below steps. The records will be sent to the patient’s portal unless otherwise indicated. The patient portal can be accessed here. If you have any questions please leave a detailed message for the records request department at 516-207-7960.

    If you are looking to retrieve your COVID test results or other lab results, please visit your patient portal or call the office where you or your child received the test. This form is for medical record chart requests.

    Temporary Guardian Authorization Form

    Please fill out the form below to authorize temporary consent for your child to be seen at PM Pediatric Care office with an adult other than yourself. Please submit this form to your nearest office along with a copy of your photo ID.

    IMPORTANT: This form is valid for one calendar year and must be renewed each year in order to be considered valid.