These are all word documents. The forms can be downloaded and edited or printed and filled out by hand.
The attached is my practice brochure
I also have another brochure associated with mental health Issues
Please complete all of the following forms before I treat you. Please print them and fill them out to save time on your first visit.
1. Permission to treat - A basic release to allow me to use needles.
Please sign both pages.
2. HIPAA compliance form. I only need the first page back.
3. Release for your insurance, if you have any that I can bill and
4. Patient intake - your medical history.
Call 646-228-6463 for an appointment.
440 State Route 32 North, New Paltz, New York 12561
(when using GPS, you really need the word 'North' in the address)
I See Patients By Appointment Only