318 East Westfield Ave. Roselle Park, NJ 07204

Forms & Policies

Before your appointment with us, quickly and conveniently access patient forms from our practice. To view the forms listed below, you will need Adobe Reader. You may download Adobe Reader for free at www.adobe.com. Please bring your completed forms with you to our office at the time of your visit.

After making  your appointment:
Our practice uses a computerized appointment confirmation system that will call your house to remind you of your upcoming appointment with our office.

Cancellation Policy:
In an effort to improve the scheduling of appointments and meet the needs of our patients, the practice has implemented a “NO SHOW & CANCELLATION POLICY”. 24 Hour advance notice is required to avoid the cancellation fee.

24 Hour advance notice is required
for all cancellations.

The following fee will be billed to your account
without proper notification.

$200.00 for procedure appointments
$100.00 for new patient appointments
$50.00 for all other appointments


Download Patient Forms


Dr Ricardo E. Rodriguez