Patient Forms

Patient Intake Forms

As you prepare for your next appointment, please take the time to review and complete our patient intake forms. We highly encourage you to thoroughly evaluate and understand these documents before your visit. Below, we have provided you direct links to our forms for consents, agreements, and policies. At the same time, review our intake forms for patient information and health history. These formal documents will assist us and you in expediting the preparation process for your next appointment.

Please complete both forms below so that we can recommend the most effective treatments and services for you.

Form #1: Patient Info &  History

This is another basic form we ask all patients to complete concerning demographics. Simply, you will be asked to fill out your name, contact information, and provide a photo identification. At the same time, you may be asked to input your date of birth, gender, and home address. This way, we can have all your information organized and on file before you arrive for your first appointment. To get started on the form, simply click the button directly below.

Form #2: Welcome Packet & Policies

These are out general forms addressing consent, medical agreement, and our policies. Within these forms, we will ask you to provide consent for treatment, authorization to release medical records, as well as financial disclosure. Additionally, these forms will highlight your patient responsibilities, telemedicine, and media consent preferences. Prior to your next appointment, simply click the link below to get started on the form.

COVID-19 Testing Form

Complete this form if you are looking to schedule a PCR/NAAT Molecular, or Rapid-Results Antigen Test for COVID-19. This form asks basic questions regarding your contact information, current symptoms, and possible exposures. It will additionally ask details regarding your upcoming availability and preferred testing method. Once you are ready to schedule a test with Sixth Borough Medical, click the button below to start filling out the form.

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Where Health COMES FIRST





WE CARE, WE CAN




201-422-2556


Contact Us

For medical emergencies, please call 911. Otherwise, we’re available to provide medial aid at any time of day.




Copyright by Sixth Borough Medical. All rights reserved. Developed by Perfect Clicks LLC.



Copyright by Sixth Borough Medical. All rights reserved. Developed by Perfect Clicks LLC.