Print Forms

Pediatric Cardiology of Long IslandYou can print out the forms we use and fill them out at home so you are ready to go when you get to the office. Most patients will use the first two forms unless you are an adult with your own insurance or coming in for a fetal echocardiogram.

Click the links below to download the PDF**

Children-Demographics (6 pages, please be as complete as possible)

New-Patient-Health-History (4 pages, please be as complete as possible)

Follow-Up-Health-History (2 pages, please be as complete as possible)

Adult Demographics (8 pages, please be as complete as possible)

Fetal-Health-History (2 pages, please be as complete as possible)

Spanish-Demographics (7 pages, please be as complete as possible)

Medical-Record-Release-from-PCLI (2 pages, please be as complete as possible)

Medical-Record-Release-to-PCLI (2 pages, please be as complete as possible)

**To view PDF files, you must have Adobe Acrobat Reader. If you don’t already have Adobe Acrobat Reader, you can download it for free here