New patient forms
New patients: please complete the forms and bring with you to your first appointment
ENGLISH

new_pt_packet29032018.pdf | |
File Size: | 4822 kb |
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SPANISH

newpatientpacket-spanish04102018_copy.pdf | |
File Size: | 4932 kb |
File Type: |
Authorization to release Information:
If you require exchange of information before your next appointment or if you are no longer receiving treatment at our office, please call 631-265-1622 if you have any questions regarding how to fill out the release forms. Completed forms can be faxed (631-265-3042) or mailed to our Smithtown office for processing.
Download and complete this form to give us permission to share your protected health information
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Download and complete this form to permit us to receive your protected health information
Download and complete this form to request that we release specific protected health information to you
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Notice of Privacy practices:

hps_npp.doc | |
File Size: | 111 kb |
File Type: | doc |