Patient Forms
Quickly and conveniently obtain forms from our office. You may bring your completed forms to the office at the time of your visit. To view the forms listed below, you will need Adobe Reader.
You may download Adobe Reader for free at www.adobe.com.
- Patient Information Form
- Consent for Release of Medical Information
- Request for Restriction on Use/Disclosure of Protected Health Information
- NYS Disability Claim Form (DB-450)
- Notice of Privacy Practices
Billing & Insurance
Our fees for office and hospital care are determined by the time spent and the complexity of the care rendered, according to insurance carrier guidelines. Please bring your current insurance card to every office visit so that we may verify your insurance coverage. We appreciate your payment at the time of your visit. We require that amounts due, such as HMO copayments, be paid at the time of service, as per your insurance carrier contract. We regret that we are unable to participate in Medicaid.
We participate with most major medical insurances. For a complete listing, please call our office or contact your insurance carrier.