Surgical Admission Packet (Printable Forms)

Thank you for choosing Cohen Children’s Medical Center (CCMC) for your child’s surgery. This information will help you and the hospital plan for your child’s procedure or surgery. 

We want to make your child’s stay as pleasant as possible. Feel free to call if we can be of any help.

Helpful Phone Numbers:
Admitting Office : 718-470-3190
Admitting Fax : 718-470-9778
Anesthesia Office : 718- 470-7390
Child Life Office : 718-470-3005
Pediatric Ambulatory Surgical Unit : 718-470-3100

Surgical Admission Printable Forms


Parent/Guardian General Information

Pre-Surgical Testing and Orientation  

Pre-Surgical Screening Forms  

Insurance Information Form