60 Dunning Road, Middletown, NY 10940 (845) 344-4477

Forms

If you are a first-time patient to our practice, please read the general instructions below. Then complete the forms below that apply to you and bring the completed forms with you to your office visit.

Please bring the following with you to your appointment:

  • Your insurance cards and a referral (if required). Please check with your insurance carrier and/or PCP.
  • Prior diagnostic testing (MRI, CT, X-RAY) that is relevant to your medical condition. We prefer the actual films, but a CD will suffice. Most radiology facilities require 24-48 hours of advance notice to process your request.
  • If yours is a worker’s comp or no-fault claim, please bring the claim number, claims address, your adjuster’s name, phone number and fax number. If you do not have this information, contact your insurance carrier.
  • Any co-payment as deemed by your insurance company.
  • Forms completed in full.

If any of the above information is missing, your appointment will likely be delayed or even rescheduled. We thank you for your cooperation and look forward to seeing you in our office.

Forms:

For all patients: Registration Forms

For worker’s comp patients: Worker’s Comp Form

Advertisements