If you are a new patient, please have the following information available to schedule an appointment:

  • Patient’s Full Name
  • Date of Birth
  • Contact Number
  • Home Address
  • Social Security Number
  • Name of Referring Physician
  • Prescription from Referring Physician (If Applicable)
  • All applicable records
  • Insurance information


Please print and  fill out the attached PDF forms  in order for your appointment to be secured.  Please fax all documents to 201-678-9189.

Patient Information     

Patient Policy   

Outpatient Consent Form

Payment Policy


If you are having a consultation with the physician, all medical records should be brought to your visit with the below Patient History form filled out. 

Patient History Form


Contact Us

To schedule an appointment or for further information regarding patient transport or consultations, please call: 551-996-2453

And/Or contact :

Alison Forte, Perinatal RN

Monday - Friday 8:00am - 4:00pm  at 551-996-3360

E-mail:  aforte@hackensackUMC.org

Magdalena Pawlik, APN

Monday - Friday 8:00am - 4:00pm  at 551-996-4938

E-mail:  mpawlik@hackensackUMC.org

For immediate transport of a patient to our facility please call 551-996-4447 (24 hours a day, 7 days a week).

All transports will be accepted in accordance to EMTALA regulations

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