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To Schedule an Appointment

Call our office at 516.280.8811 to make an appointment during our regularly scheduled office hours:

Download the forms that apply to you. Print them out and bring the completed forms with you to be seen more quickly by the therapist on the day of your appointment. 

Forms for All Patients

INTAKE FORM

MEDICAL HISTORY

REVIEW OF SYSTEMS

MEDICATION LIST

ACKNOWLEDGEMENT OF RECEIPT OF HIPAA

CONSENT FOR CARE / BENEFIT ASSIGNMENT / MEDICAL RECORD AUTHORIZATION

AUTHORIZATION TO PAY

Download any of the forms below if applicable

NEW YORK MOTOR VEHICLE NO-FAULT INSURANCE LAW ASSIGNMENT OF BENEFITS

AGREEMENT TO PAY IF WORKERS COMPENSATION IF CLAIM IS DENIED

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