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