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Patient Forms

Consent Forms & Financial Policy/Cancellation Form:

 Patient Consent Form
Financial Policy Form

If you have Medicare as your primary insurance fill all these forms out:

Medicare
Pain Scale
Medication Form
OPTIMAL Form

Medicare and all other insurances, print, fill out this paperwork:

All Patients Fill This Out 1
All Patients Fill This Out 2

New Employee Paperwork

If you are a new employee, print and fill out all of the following paperwork. Also bring with you a photocopy of either the photo page of your US Passport or a photocopy of your Drivers License and Social Security Card.

Employee Application
Non Compete Agreement
Federal I-9 Form

LiteCure Laser Consent Form

If you are interested in Laser Therapy, print, read carefully and sign this paperwork:

Laser Consent Form

Insurance

ACCEPTED IN NETWORK

Medicare  -  Medicaid  -  BCBS  -  Cigna  -  UHC  -  1199  

 No Fault  -  Workers' Comp(Except MagnaComp)  -  All Local Union Plans

 

ACCEPTED OUT OF NETWORK

Aetna  -  Empire Plan(MPN)  -  GHI(Emblem Health)  -  MagnaCare  -  Oxford 

 

WE DO NOT TAKE

ElderPlan  -  EverCare  -  FIDELIS  -  HealthPlus  -  HealthFirst  -  MetroPlus  -  HIP/HCP

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