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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.​

Patient Registration Packet

To expedite the registration and check-in process, please fill out this form prior to your visit.

Pain Management (Initial Consultation Packet)

For patients with an initial consultation, please complete this packet before arrival.

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. 821.

Consent to Unencrypted Email & Text Communication

To receive email & text messages without encryption, please fill out and call (718) 667-7500 ext. 821.

Worker's Compensation or No Fault Injury Packet

If you were injured while on the job or a vehicle accident, please fill out this form.

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