Patient Forms

Our printable registration forms and payment options are available below:

• Adult Registration Form (PDF, 1 page)
• Child Registration Form (PDF, 1 page)
• Payment Options  (PDF, 1 page)
• Consent for Release  (PDF, 1page)
• Medical History  (PDF, 5 pages)

Apply for our Interest-Free billing service

• See Payment Options at left.

• For charges less than $500, the Practice offers 6 months
  same as cash when you are accepted by Care Credit and                                                                                                               pay in full within 6 months.

• For charges more than $500, the Practice offers 12 months
  same as cash when you are accepted by Care Credit,
  and pay-in-full within 12 months.

• To apply for Care Credit click here.

• (Financing available to residents in the state of New York)

Adobe Acrobat Reader is a free program for PC and Mac computers that will allow you to view and print Portable Document Format (PDF) files on our website.