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Patient Forms

Family Health Center located in Arverne, Far Rockaway, Jamaica, and Red Hook, Brooklyn, NY

At JPAFHC, we are committed to making your registration experience as smooth and efficient as possible. Prior to your first visit, patients are asked to complete required registration forms to support accurate records, protect your privacy, and ensure you understand your rights and responsibilities as a patient.

What to Bring to Your First Visit

Completing your registration forms ahead of time and bringing the appropriate documentation will help ensure a timely and efficient visit. Please bring the following items to your appointment:

FOR ADULTS/SPECIALISTS

• Photo ID
• Insurance card
• Proof of income for self-pay patients/patients without insurance
• Referral for specialist
• Social Security card
• If you are not working, a notarized letter of support is required.

FOR PEDIATRICS

• Biological parent or legal guardian must accompany the child at initial visit.
• Proof of guardianship if you are not the parent
• Birth certificate or passport for the child
• Immunization records
• Insurance information for the child
• Photo ID of biological parent or legal guardian
• Proof of address (driver’s license, utility bill)
• Proof of income for patients without insurance

Patient Registration Forms

We encourage you to review and complete these forms in advance to help streamline your check-in process. Forms can be completed online or printed and brought with you to your appointment. Completing your registration forms ahead of time and bringing the appropriate documentation will help ensure a timely and efficient visit.

Notice of Privacy Practices for Protected Health Information

Extended Hours of Operation/After-Hours Access

Arverne
6200 Beach Channel Drive, Arverne, NY 11692
Far Rockaway
1288 Central Avenue, Far Rockaway, NY 11691
Jamaica
114‑39 Sutphin Boulevard, Jamaica, NY 11434
Jamaica
118-11 Guy R. Brewer Boulevard, Jamaica, NY 11434
Brooklyn
120 Richards Street, Brooklyn, NY 11236