Patient forms

New Patient Intake Forms
Patient Intake Form DOWNLOAD
Patient Medical History DOWNLOAD
Accountable Care Organization DOWNLOAD
Non-Participating Disclosure & Consent (English) DOWNLOAD
Non-Participating Disclosure & Consent (Español) DOWNLOAD
NYS Out-of-Network Surprise Medical Bill DOWNLOAD
Authorization for Release of Health Information DOWNLOAD
Lumbar Patient Form
New Patient Lumbar Form DOWNLOAD
Cervical Patient Form
New Patient Cervical Form DOWNLOAD
Physical Therapy Forms
Back Index DOWNLOAD
Hip_Leg Lower Extremity DOWNLOAD
Neck DOWNLOAD
Shoulder Elbow Wrist & Hand DOWNLOAD

Notice of Privacy Practices

This notice describes how medical information about you may be used and disclosed and how you can get access to this information.

For more information, please visit Columbia University Medical Center’s Health Insurance Portability & Accountability Act (HIPAA) Information page.

HIPAA Media Consent Forms
CUMC Media Consent Form DOWNLOAD
Neurological Associates Media Consent Form DOWNLOAD
NYP Media Consent Form DOWNLOAD
Email Communication
Email Communication Form DOWNLOAD
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