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Forms and Policies

Home Forms and Policies
Forms and Policies

Our office provides comprehensive medical care for children from newborns to 21 years. The visits to the office are by appointment only. If you are late for your appointment and have not called and made arrangements, you may have to be rescheduled. We try to maintain your appointment schedule as well. However, sometimes emergencies and unpredictable circumstances during another patient’s visit might delay your appointment. Same day cancellations of appointments are subject to a cancellation fee. It is extremely important that you bring all of your child’s health and insurance information to the visit to prevent any inconvenience and delay in attendance to your child. If the child is sick and needs to be seen, we will try to accommodate the child that same day if the office schedule permits.

Don’t forget to call our office to verify and ensure that we participate with your insurance plan as participation may have changed. If you are required to have a primary care physician by your insurance plan, Dr. Naveen Mehrotra must be listed as the primary care physician on your card to cover the visit or we will not be able to see your child in the office. It is your responsibility to have the proper insurance information to be seen. If your plan requires a copayment, coinsurance, or deductible which is due at the time of the visit, it must be taken care of at the time of the visit.

If you have recently moved into the area or are looking for a new pediatrician, please call the office and schedule an appointment for a visit. Prior to the visit, please contact your previous pediatrician and ask for your child’s records to be transferred to Dr. Mehrotra’s office. The Release of Records form that needs to be given to the previous pediatrician is available on this site for your convenience. Any fees associated with the file/transfer of the file, is your responsibility and should be handled directly with their office.

There is a $25 charge for same day cancellations of appointments.
There is a $20 charge for the Release of records (Includes copy and mailing charges)
There is a $2 charge for a copy of the immunization records after your visit. (Please ensure that you get your immunization card completed at the time of the visit)
Our office offers ear piercing at $65 payable at the time of the service (includes ear studs). An appointment needs to be made for this separately.
There is a $5 charge to complete all school related, camp, work, and other forms.
Travel vaccinations may not be covered by the insurance company. Please check this before you get your vaccinations.
Our fees for various services are as follows and are payable by cash,check, or credit cards:

All charges not covered by the insurance company are the responsibility of the patient. Policies are subject to change without notice. Please do check with the office for updated information/changes in policies.


If you have any questions, feel free to reach us at:
Piscataway office Edison office Elizabeth office North Brunswick office New Brunswick office
FAX: 732-819-8801

PH : 732-819-8800
FAX: 732-738-9585

PH: 732-738-1341
FAX: 908-659-1001

PH: 908-289-2239
FAX: 732-398-9030

PH: 732-398-0900
FAX: 732-545-9877

PH: 732-545-9878

For your convenience here are common forms that can be downloaded and completed prior to your visit to expedite your visit.


Typically form completion will take 3-5 business days so please plan accordingly. Same day forms will not be accommodated. Child must have had an active physical in the last one year for form completion.

Patient Registration form Download PDF FORM
Patient Consent form Download PDF FORM
Assignment of Insurance Benefits Download PDF FORM
Release of Records to Edison Office Download PDF FORM
Release of Records to Elizabeth Office Download PDF FORM
Release of Records to Piscataway Office Download PDF FORM
Release of Records to North Brunswick Office Download PDF FORM
Release of Records to New Brunswick Office Download PDF FORM
Authorization for a Secondary caretaker Download PDF FORM