Required Registration Forms




Our Online Appointment Scheduler is available 24/7 to help set up your next appointment with Dr. Pontillo, Dr. Gamboa or Nicole Smokler-Monsowitz.

Notice For New Patients

When you arrive at your appointment, please turn on the light next to Dr. Pontillo’s name. She will pick you up from the waiting room promptly at your appointment time.
There is ample free parking available at Dr. Pontillo’s building with no time restrictions.
Please download and fill out all of the forms below and bring them to your first appointment.

1. Intake Form
2. Informed Consent – As this is a legal agreement, please print out this document in its entirety.
3. Release Form – This form allows for Dr. Pontillo to contact your child’s pediatrician, teacher, or anyone else you name who is involved in the care of your child.
4. HIPAA form – For your records only.
5. Credit Card Authorization Form

School Observations

If you would like Dr. Pontillo to schedule an observation of your child at his/her school, please complete and submit the following release form.

School Observation Release Form