Patient Forms
Our registration forms and payment options are available
below:
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Adult
Registration Form (PDF, 1 page)
-
Child Registration
Form (PDF, 1 page)
-
Payment
Options (PDF, 1 page)
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Apply for our Interest-Free
billing service
-
See Payment
Options at left.
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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)

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