Patient Forms

Patient Forms

If you are a new patient or have not been to the office within the past 12 months, please download, print and complete our Patient Registration Forms below prior to coming to the office. You may either fax them to 212-675-0540 or bring them in the day of your appointment to expedite your check-in process. Remember to also bring your current insurance card, photo ID and valid referral if required by your insurance.

Download Patient Registration Forms

The office generally runs on time. Please arrive 15 minutes prior to your appointment time to complete the new patient paperwork and have your photo ID and insurance card scanned into the system. If your insurance requires a referral, please bring the referral along with you.

We look forward to seeing you at your upcoming appointment. This appointment is reserved for you, and while most patients are able to keep their appointments, we ask that if you must cancel or reschedule, you do so no less than 24 hours prior to your scheduled visit. In order to maintain a smooth patient flow and accommodate all patients, there is a $50 cancellation fee for medical visits and a $200 cancellation fee for cosmetic treatment visits automatically billed to patients who cancel/reschedule less than 24 hours in advance or fail to keep their appointment.

Patients without required referrals will be asked to reschedule.

Medical Records Release Form

Parental Consent for Treatment of a Minor

General Treatment Consent

You may also familiarize yourself with the

HIPPA Notice of Privacy Practices

Please see the Appointments page for more details.