New & Returning Patient Forms

At NYC Pupil, we value your time. In an effort to save you time in our office, please complete our patient form(s) prior to your appointment.

New Patients:

We try our best to save paper and time. Please support us in this endeavor and complete all necessary forms/tabs online.

Please click on the "PATIENT FORMS" link and follow the directions for all NEW patients.

Please complete the following steps: 

  • DEMOGRAPHICS (FIRST TAB) - REQUIRED
  • PATIENT HISTORY & REASON FOR VISIT (Fill out only those tabs that are appropriate for you or your child) - REQUIRED 
  • POLICIES, CONSENT and SUBMIT (LAST TAB) - REQUIRED

Below are the links for the:

New Patient Form

Patient Portal


Existing Patients:

If you have moved or any of your patient information has changed please contact our office by calling or texting 718-481-2020.

We will generate a pass code allowing you to verify and update your patient information.

PRINTABLE FORMS:

You will need AdobeReaderĀ® to download and complete the forms. Click here to download.
Download the required form(s). Print out the form(s) and complete the required information.

Below is the link for:

Existing Patients

NYC Pupil

Address

4079 Richmond Ave.,
Staten Island, NY 10312

Phone

718-481-2020

Monday  

Closed

Tuesday  

9:00 am - 6:00 pm

Wednesday  

Closed

Thursday  

9:00 am - 6:00 pm

Friday  

Closed

Saturday  

8:00 am - 2:00 pm

Sunday  

Closed