New Patient Forms & Office Policies Packet

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Read Our Office Policies

OFFICE POLICIES

See  Our Menu of Services & Fee Schedule

MENU OF SERVICES-FEE SCHEDULE

Print & Complete Your Medical Records Request Form

Download Medical Records Request Form

To be completed by you and faxed to your doctor(s) who may have your labs. They need your approval to release to another doctor (me). Labs can be faxed directly from the doctor to my office at 845-876-5559.

Please bring the following forms to your first visit completed:

Print & Sign Your Informed Consent

INFORMED CONSENT

Print & Complete Your Patient Initial Intake Forms

ADULT:

PatientProfile

PEDIATRIC (up to 12 years old)

pediatric_intake_form

Print & Complete Lyme Questionnaire

Lyme Questionnaire

Print & Complete Lifestyle & Detox Assessment

Lifestyle & Toxicity Questionnaire

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