Patient Forms

Come prepared for your visit by choosing one or more of the forms listed below. 

At Healthcare Associates in Medicine, we make every effort to make your waiting time as quick as possible. To save time you can access forms listed below to complete before coming to the office.

 

Just click on the link, print the form, fill it out and bring it with you to your appointment.​

New Patient Form

If you've never visited any of our offices or walk-in centers, please fill out this form.

Patient Post-op, Fracture Care, Injection Form

If you're returning to our office for the listed treatments, please fill out this form.

HIPAA Authorization - Medical Records Release Form

If you're requesting medical records, please fill out and bring this form or call (718) 667-7500 ext. 816.

Medical Permission to Treat a Minor Form

If you're a parent or guardian accompanying a child, please fill out this form.

New York Motor Vehicle No-Fault Assignment of Benefits Form

If you were injured in a motorcycle or motor vehicle accident, please fill out this form.

Claimant's Authorization to Disclose Worker's Compensation Records Form

If you got hurt while on the job, please fill out this form.

CALL: (718) 667-7500

TEXT US: (929) 203-8684

Our representatives are available

to assist you during normal business hours.

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