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Forms

Please send all form requests/pre- completed forms to the Patient Portal.
https://patientportal.intelichart.com/login
**If you are not already registered for the portal, you will need a pin for your child. Please give the office a call if this is the case.**
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      SCHOOL, ATHLETIC, CAMP FORMS/ ADMINISTRATIVE FORMS/ MEDICAL LETTERS 

The fee to complete school/camp/athletic forms is $15 per child.  Forms will not be processed until the fee is paid.   Processing takes up to 5 business days from the time payment is received.  If you need the forms expedited, the fee is $25 for a 24 hour turnaround.

This fee is not covered by insurance. 

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      WORKING PAPERS

As of June 1, 2023, Working Papers for minors have gone digital. Minor workers, their caregivers, and employers all fill out their respective parts of our streamlined online application instead of using the old paper form. Click here to download a handout explaining the new process.

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      MEDICAL RECORDS

You must make the request for a copy of your child’s file using our medical record request form. Once your request is received we will contact you about the fee to complete your request. This process can take up to 30 days from receipt of written request.

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VACCINATION RECORDS

Please send the request through the patient portal for vaccine records. There is no charge for this.

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Randolph Pediatrics • 711 Route 10 East • Suite 201• Randolph, NJ • 07869

Phone: 973-328-9200   
     Fax: 973-328-9144
Appointments cannot be requested via email or the patient portal, please call to schedule all appointments. 

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