Patient Forms

For your convenience, you can download the patient forms and complete them prior to your first visit. Then, bring the forms with you when you come in for your appointment. If you choose to fill out the patient form packet at our office, please arrive 10-15 minutes before your appointment to allow enough time to get them completed.

Our forms are PDF files. To download and print the forms, you'll need the free Adobe Acrobat Reader program.

Private Insurance Physical Therapy Patients

Please download the patient intake forms and the form(s) that pertain to the area we are treating:

• Neck
• Shoulder/Arm/Hand
• Back
• Lower Extremities

If the patient is under the age of 18, please also download the Consent to Treat a Minor form.

Formas en Español

Por favor, descargue la forma o formas que pertenecen a la zona que estamos tratando:

• Cuello
• Hombro/Brazo/Mano
• Espalda
• Estremidades Inferior

Physical Therapy Without a Dr. Prescription

• Direct Access Attestation

Medicare Physical Therapy Patients

Please also download:

• About Your Medicare Benefits

Oxford and The Empire Plan Patients

Please also download:

• Patient Summary Form

Government The Empire Plan Patients

Please also download:

• About Your Empire Plan
• Medicare Primary / The Empire Plan Secondary Patients

HIP Insurance Patients

Please also download:

• Hip Insurance Form

Notice of Privacy Practices

All patients, please download:

• Notice of Privacy Practices (English)
• Aviso de Prácticas de Privacidad (Español)

Fitness and Personal Training Clients

• Fitness Contract

Massage Clients

• Massage Forms

If you have any questions or need assistance please feel free to contact us at (516) 623-4388. You may also go to our FAQ page and listen to the short clip on what to expect on your 1st visit.