Patient Information

Patient Forms

The following forms can be downloaded to your computer and printed at home. By filling out these forms ahead of time, you will save a significant amount of time during your visit. Please be prepared to provide this information to our office along with your current medical insurance information. If you have any questions when filling out these forms, please do the best you can and our staff will assist you with your questions on the day of your visit.

Medical History

Patient Registration

Need Adobe Acrobat Reader?

If you do not have a copy of Acrobat Reader you can get one for free by clicking on the icon 'Get Acrobat® Reader'. This will take you to Adobe's website and enable you to download the Acrobat program to your computer.

Accepted Insurances

We participate with the following insurance carriers. Although we make every effort to update this information frequently, you should call your insurance company to verify our participation. You may also contact us at 212.242.5815 with any questions.

1199
32 BJ (BCBS)
AARP
Anthem (BCBS)
Aetna - HMO
Aetna - PPO, POS
Aetna - EPO, OPEN ACCESS
Aetna (St. Vincent's Plan)
BCBS (PPO, EPO, POS, Federal, Direct)
BCBS (HMO, Direct Pay HMOs, Child Health Plus)
Cigna Benefice Advantage
Cigna PPO, HMO, POS
Consumer's Health Network
Empire Government (UHC, PPO)
First Health (NO MEDICAID)
GHI

Great West (NOW CIGNA)
Healthnet
Horizon Healthcare of NY (BCBS)
Horizon Healthcare HMO (Healthy NY)
Medicare (NO GHI, BCBS, or MEDICAID)
Multiplan
Mutual of Omaha (PPO)
Oxford (FREEDOM, LIBERTY, SELECT, MEDICARE)
PHCS
PHS/ Healthnet
Pomco
Unicare
Union Labor Life/ Cigna
United Health Care (NO MEDICAID)

Payment Options

Payment is due at the time of service. If we participate in your insurance plan the estimated patient portion is due at the time services are rendered. Please call our office for more information at 212.242.5815.

The following credit cards are accepted for payment: