[vc_row type=”vc_default” css=”.vc_custom_1474221376872{margin-bottom: -80px !important;}”][vc_column offset=”vc_col-lg-8 vc_col-md-8 vc_col-xs-12″ css=”.vc_custom_1463573458077{margin-bottom: 80px !important;}”][ultimate_heading main_heading=”Patient Forms” alignment=”left” main_heading_style=”font-weight:bold;” sub_heading_font_size=”desktop:14px;” sub_heading_line_height=”desktop:28px;” main_heading_margin=”margin-bottom:22px;” sub_heading_margin=”margin-bottom:30px;” main_heading_font_size=”desktop:24px;” main_heading_line_height=”desktop:30px;”][/ultimate_heading][vc_column_text]
We make it easy by providing all the forms you need, in one place.
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New Patients
- New Patient Intake
- New Patient and HIPAA Forms – (please print, fill out and bring to the office)
- Workers Compensation Form
- No Fault Form
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Physician Referrals
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Current Patients
- Pre-Certification Form
- Prescription Request Form
- Health Insurance Portability and Accountability Act (HIPAA) Form
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Surgical Patients
[/dt_vc_list][vc_empty_space][vc_separator color=”custom” border_width=”2″ accent_color=”#0c2961″][vc_row_inner css=”.vc_custom_1462354927208{padding-top: 22px !important;padding-bottom: 20px !important;}”][vc_column_inner][/vc_column_inner][/vc_row_inner][/vc_column][vc_column offset=”vc_col-lg-4 vc_col-md-4 vc_col-xs-12″ el_class=”custom_sidebar” css=”.vc_custom_1474221370251{padding-bottom: 80px !important;}”][vc_row_inner css=”.vc_custom_1462516802446{padding-right: 25px !important;padding-left: 25px !important;}”][vc_column_inner css=”.vc_custom_1471295267122{padding-top: 30px !important;padding-right: 30px !important;padding-bottom: 20px !important;padding-left: 30px !important;background-color: #f4f4f4 !important;}”][ultimate_heading main_heading=”Request an appointment” heading_tag=”h3″ alignment=”left” main_heading_margin=”margin-bottom:20px;” main_heading_style=”font-weight:bold;”][/ultimate_heading][vc_column_text]We encourage you to contact us whenever you have an interest or concern about our services. You can reach us during office hours at 212.249-8100 or fill out the form below and submit it any time of day or night. Our doctors or knowledgeable staff will be in touch.[/vc_column_text][vc_empty_space height=”30px”][dt_contact_form fields=”name,email,telephone,message” message_height=”2″ required=”name,email” button_size=”medium”][/vc_column_inner][/vc_row_inner][/vc_column][/vc_row]