226 Seventh Street, Suite 101
Garden City, NY  11530
Phone:  516.747.1520 / Fax: 516.747.1552
"Thank you for all your help. It really brightens my day when I come here."-- Mr. Z.
Click Here for New Patient Forms

If you are a NEW patient, please complete the below forms before your appointment:

 

 

1) The Patient Registration Form This form provides important information such as general information about you, your condition and/or injury and other pertinent personal data. Please download the form and fill it out prior to your first visit, just to make your visit run a little more smoothly. Don't worry, you can always fill out the form in the office.

 

2) The Past Medical History Form: We will also ask you to fill out a form concerning your medical history. This information is important in helping us understand the nature of your injuries or condition, and to be informed as to any medical constraints that you may have. Please be sure to bring your insurance card, as we will need to make a photocopy of it for our records.

 

3) The Privacy Statement Form: In providing physical therapy to you, we create and store health information that identifies you. Your "Medical information" refers to any information about you, that may identify you and that relates to: your past, present or future physical or mental health or condition, to the provision of health care to you, or the payment history for your health care. We understand that this information about you and your health is personal, and we are committed to protecting your privacy. We must obtain your one time consent before we treat you and obtain payment for our services. Please sign the Notice of Privacy Practices form, and bring it with you upon your first visit.

 

4)  Appointment Cancellation Policy:  We understand that there are times you must miss an appointment due to emergencies or obligations for work or family.  If that happens, we respectfully ask for scheduled appointments to be cancelled at least 24 hours in advance.  Thank you for being a valued patient and for your cooperation. 

 

5)  Electric Stimulation Pad Policy:  As per our policy, we must require all patients receiving Electric Stimulation therapy to purchase their own stim pads.  This is important, and stimulation therapy cannot be provided if you do not purchase your own pads.  COST:  $10



Doctors: Click here for Adult Rx Pad

Doctors: Click here for Kids Rx Pad

226 Seventh Street Suite 101   Garden City, NY 11530

Phone516-747-1520      Fax: 516-747-1552