Patient Forms

For your convenience you may print out and then fill out the forms listed below and either mail, email, fax or bring them to our office on the day of your first visit. Contact info can be found here. Or you may fill the forms out at our office when you arrive for your first appointment. If you wish to fill them out at the office please arrive 15 minutes early so that your evaluation and treatment can begin on schedule.

Patient Information

Choose form(s) for applicable body part(s):

       - Back

       - Neck

- Upper Extremity (Hands, Wrists, Elbows, Shoulders)

- Lower Extremity (Feet, Ankles, Knees, Hips)

 

Additional forms needed for those with *NYS Empire Plan

Patient Summary

Screening Test (For Back Only)


Health Insurance

We participate in and accept most major health insurance company plans. If you do not see yours listed please call us to verify your coverage.

Aetna

Blue Shield

CDPHP

Cigna

Empire BCBS

Fidelis

First Health/Coventry

GHI/Emblem Health

Healthnet

Health Republic/MagnaCare

Humana

Martin’s Point

Medicaid 

Medicare

Multiplan

MVP

No Fault

NYS Empire Plan

Oxford

POMCO

Secure Horizons

Senior Whole Health

Tricare (with the exception of active-duty members)

United Healthcare

Univera

Wellcare

Workers Compensation