Demographic, medical history and insurance forms will be available electronically via our Patient Portal or 𝑐𝑙𝑖𝑐𝑘𝑖𝑛𝑔 𝑜𝑛 𝑁𝑒𝑤 𝑃𝑎𝑡𝑖𝑒𝑛𝑡 𝐼𝑛𝑓𝑜/𝑀𝑒𝑑𝑖𝑐𝑎𝑙 𝐻𝑖𝑠𝑡𝑜𝑟𝑦, please fill them in before your visit.
Signing "Acknowledgment of Receipt of Privacy Practices" on the form signifies that you have read the Privacy Policy, listed below. [NOTE: This PDF requires a free plugin that may have come included with your browser. If you are having difficulties opening this file Click Here to go to Adobe's web site for Acrobat Reader.] |
Shades Of Brooklyn
1619 Pitkin Avenue Brooklyn, New York 11212 Phone: 718-342-4300 Fax: 347-350-6601 |