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Patient 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

MPN/Empire Plan & United Healthcare
Patient Form
– Back Index
Neck Index
Lower Extremity Index (LEFS)
Upper Extremity Index (DASH)

Blue Shield NENY
Patient insurance forms no longer necessary

These forms are in PDF format, and will need Adobe Acrobat Reader to view them.
If you need the reader, you can download it here.

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