BRIGHTON WELLNESS CENTER
2 Brighton Road Suite:404
Mon-Fri : 8am to 6pm
Sat : Well visits by request

CLIFTON FAST-TRACK
1115 Clifton Ave Suite:101
Mon-Fri : 12pm to 8pm
Sat : 9am to 2pm & Sun : 10am-1pm

Tel : 973.250.2970
Fax : 973.250.2971
English
  • Spanish

Registration Forms

Forms below are provided to help make your visit to our office as convenient for you as possible.

New Patient Registration

Before coming to our office please fill these forms and either email or bring it with you on the date of your appointment.

New Patient Registration Form

Medical Release Form

If you are coming from a different pediatrician’s office, you can use this form to request your child’s medical records be sent to us. You can print the attached form and fax it to your previous pediatrician. Download

Universal Child Health Record

These are the forms needed for daycare, school, and camps. Complete section one and bring the form with you on the date of your child’s physical examination. Download

Sports Physical Form

This form is needed for your child if he or she wants to participate in sports. Complete the questionnaire in Part A before your child’s appointment. Download

NuHeights Pediatrics Staff