Welcome to
Your Membership
Onboarding
Thank you for joining our practice.
To help us provide you with the highest level of personalized care, please complete the following
onboarding forms.
Welcome to
Your Membership
Onboarding
Thank you for joining our practice. To help us provide you with the highest level of personalized care, please complete the following onboarding forms.
All documents are private and HIPAA compliant
Designed to save time at your first visit
Our team is here if you need help
-
All documents are private
and HIPAA compliant
-
Designed to save time
at your first visit
-
Our team is here if you
need help
What To Expect
What Happens Next:
- Download and complete the forms below
- Return them via mail, email, or drop them off at our office
- Our team will review and confirm your onboarding
- You’re officially ready for care!
Required Membership Documents
Please download, review, print
and complete the following documents. Click Below to download the full set of documents.
See Description of the Documents you will be filling out below:
Membership
Agreement
Outlines the terms and expectations of your
membership.
Plan Description
and Pricing Plan
A summary of your selected membership plan and pricing.
Membership
Payment
Agreement
Confirms billing details and payment authorization
Membership Agreement
Outlines the terms and expectations of your membership.
Plan Description and Pricing Overview
A summary of your
selected membership
plan.
Membership Payment Agreement
Confirms billing details and payment authorization
Patient Intake Form
Helps us understand your medical history and personal needs.
HIPAA Aknowledgement
Confirms your understanding of privacy rights and protection.
Authorization to Release Medical Records
Allows us to request records from previous providers.
Patient
Intake Form
Helps us understand your medical history and personal needs.
HIPAA
Acknowledgement
Confirms your understanding of privacy rights and protection.
Authorization to
Release Medical
Records
Allows us to request records from previous providers.
How to Return Your Forms:
- Mail: 100 Manetto Hill Road Suite 107 Plainview, New York 11803
- Drop Off: Forms may be dropped off during office hours
Need Help Completing Your Forms?
Our team is happy to assist you.
Need Help Completing Your Forms?
to assist you.