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patient forms 

After scheduling your appointment, please complete each form, print out and bring with you on your appointment day. 

All patients must fill these forms below:

*For medicare patients only.

Additional forms may be needed: 

A direct access form is needed if you do not have a Doctors prescription upon your first visit.

*For medicare patients only.

An advanced beneficiary notice is needed if you use Medicare but do not decide to submit your Physical Therapy bill to Medicare. 

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You can fill this form out at your initial visit. 

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visit us

Monday - Friday
8:00 AM - 6:30 PM

Tel. 212-541-8450/212 - 541 - 1606

Fax. 212-541-8582

53 Columbus Ave

Suite 4 

New York, NY 10023

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