Please complete an intake form prior to your first visit to help the

doctor better understand your needs.  

For your convenience, these are available for download below.  

Please print out and bring completed forms to your visit to avoid a delay in your appointment.  

These forms can also be obtained from the doctor's office through

U.S. mail, fax or email upon request.  

The pediatric form should be completed for patients aged 12 and under.

Complete Adult Intake Form

Complete Pediatic Intake Form

Patient Privacy Policy

Release Forms

Closing of Practice


311 North Street, Suite 307 •  White Plains, New York  10605


Phone- 914•358•9559  •  Fax- 914•358•9560 




This email is intended for basic informational purposes only.

Do not send health-related questions or details of your health condition via email. If you need to convey this information, please call the office.  Established patients should either phone in their health concerns or use the Patient Portal to send secure messages.

WEBSITE DISCLAIMER: The information contained on this website has not been evaluated by The Food and Drug Administration and is for educational purposes only. It is not meant to diagnose, treat, cure, or prevent any disease. Individuals suffering from any disease or illness, should consult in person with a physician or health care professional. Unsolicited patient email may not be answered and is not a substitute for obtaining medical advice in person from a health professional.


PATIENT TESTIMONIALS DISCLAIMER: The procedures displayed on this website may not be suitable for every patient. All patients must be evaluated by a physician to determine the appropriateness of the procedure. The testimonials represent each individual's response to their treatment; however, no medical procedure is risk-free. Potential risks and complications should be discussed with the physician rendering these procedures.

COPYRIGHT© 2018 Katherine J. Scoville DO. P.C. 

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