The following forms can be downloaded to your computer and printed at home to bring to our office or faxed to us at (516) 482-0158. In order for our doctors to provide a complete and comprehensive medical opinion it is important that they review all your medical information. Please be prepared to provide this information to our office along with your current medical insurance information. Below is a list of new patient forms, no fault patient forms and workers' compensation forms. If you have any questions when filling out these forms, please do the best you can and our staff will assist you with your questions on the day of your visit.


New Patient Forms:
 

 
No Fault Patient Forms

In addition to the new patient forms, please fill out the following forms if you are coming in for a car accident related injury that has been reported.
 

Workers' Compensation Forms

In addition to the new patient forms, please fill out the following forms if you are coming in for a work related injury that has been reported.
 

Need Adobe Acrobat Reader?

If you do not have a copy of Acrobat Reader you can get one for free by clicking on the icon 'Get Acrobat® Reader'. This will take you to Adobe's website and enable you to download the Acrobat program to your computer.

 

 

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Physicians:  Jeffrey F. Shapiro, MD  James M. Kipnis, MD    Dylan J. O'Rourke, RPA-C    Michael C . Knob, PT
Services:  General Orthopedics   Total Joint Replacements   Sports Medicine   Physical Therapy   Acupuncture   Massage Therapy

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