Please print and complete parts 1 and 2 of the initial intake forms.

Select insurance
(part 1):

Hip, Vytra, GHI

BC/BC, Cigna, Magnacare, Health Republic
No Insurance, 1199

Medicare

MPN, UHC, Aetna, Oxford

Workers Compensation Intake Forms

No Fault Intake Forms

Intake Form
(part 2: to be completed by all patients):

Initial Packet Part 2

We participate with most insurance plans at our office including but not limited to the following:

• NYS Empire Plan
• Empire Blue Cross/ Blue Shield HMO/POS/PPO
• United HealthCare
• Aetna
• CIGNA
• Oxford
• HIP
• GHI
• Local 1199
• Horizon
• Magnacare
• Multiplan
• Medicare
• NYS Workers Compensation
• No-Fault/Auto Accidents
• Suffolk County BC/BS
• Oscar
• Age Well
• Federal Workers Compensation
• Additional Medicare Plans ( Aetna, Mediblue, Medicare Advantage, Agewell)
• Union Plans