OFFICE FORMS


To streamline and simplify your initial office visit, please download and fill out these basic office forms.

Initial Forms For All Patients
- Initial Intake Form
- Informed Consent Form

Insurance Forms

For your convenience and ours, here are the forms for all the major insurance companies that we participate with.

American Specialty Health (Empire Blue Cross)
-Initial Form
-Progress Form

MPN/Empire Plan & United Healthcare
-Patient Form
-Back Index
-Neck Index

Blue Shield NENY/ Palladian Health
-Neck Form
-Inital (OS) Form
-Update (VAS) Form

These forms are in format, and will need Adobe Acrobat Redaer to view them.
If you need the reader, you can download it by clicking this image.

Rave Reviews

"I've used chiropractic care during my pregnancies for lower back pain, sciatic nerve problems and neck pain. Dr. Rugoff helped me through the pregnancies.I'd suggest it to anyone" - Margaret M.