Once you have scheduled an appointment, you can fill out the patient forms at home, or you can come in 15-20 minutes before your appointment to fill out the paperwork in our office. The necessary forms for your visit include the registration form, patient consent form, electronic prescribing and demographic form, and your corresponding doctor’s history form.
Here is a list of items that you should bring with you:
- Insurance card(s)
- Photo identification, such as a driver's license
- Referral form (for HMO insurance, if required)
- List of current medications you are taking including prescriptions, over-the-counter medications and any herbs (do not hesitate to just bring in the bottles if you are unsure)
- Current pharmacy information
- Relevant information about your medical and surgical history
Having these items ready will help us ensure a smooth office visit.
As of March 27, 2016, NYS Public Health Law requires your prescriber to electronically prescribe (e-prescribe) all your prescription medications directly to your pharmacy. Prescriptions will no longer be handwritten or called in to your pharmacy, except in limited circumstances.
When requesting prescription refills, please make sure that our office has up-to-date pharmacy information so that we may electronically send your prescriptions to the correct pharmacy. If you use more than one pharmacy, please indicate which pharmacy you would like us to use when requesting your refills.
Please click here for more information from the NYS Department of Health and for answers to frequently asked questions.
To request prescription refills, please call (212) 752-2000 option 5.
- Registration Form
- Patient Consent Form
- Electronic Prescribing and Demographic Form
- Dr. Campagna and Dr. Feuerbach Patient History Form
- Dr. Healy Patient History Form
- Patient History Form (excluding Drs. Campagna, Feuerbach, Goldberg and Healy)
- Medical Records Release Form
- Health Care Proxy Form
- Medicare Annual Wellness Visit Patient Forms