Our Forms

These are available in two formats:

1) A PDF file to print and handwrite information. If typing is difficult for you, use this form.

2) A Word document on which you can type in information.

Please use whichever is more convenient for you. For both formats, the signature pages at the end will need to be printed, signed, and brought in to give to the All Worlds staff.

 

FORM for ADULTS:

New Patient Forms for Adults (PDF to fill in by handwriting) OR

New Patient Forms for Adults (Word doc to fill in by typing)

 

FORM for pediatric patients (under 18-years-old):

New Patient Form for Pediatrics (PDF to fill in by handwriting) OR

New Patient Form for Pediatrics (Word doc to fill in by typing)

Request for Health Records

*To avoid any delays, please request just the most pertinent information (such as patient summary, last check-up, labs and imaging studies) rather than requesting the whole chart be sent.

The following information is designed to help you file and receive timely payment from your insurance company.

All Worlds Health & Pediatrics, PC does not contract with any insurance carrier. It is an “Out-of-Network” provider. Currently, we do provide a courtesy “superbill” or coding sheet with the proper codes needed for filing. If further paperwork is requested by the insurance company, we reserve the right to charge an additional paperwork fee. We will notify you prior to doing so.

Tips for Filing WIth Your Insurance Company