MIDTOWN PRIMARY CARE AND TRAVEL VACCINATIONS

PATIENT REGISTRATION FORMS

Please complete the New Patient Registration Packet. It is best to complete the forms onscreen, but then you will need to print them out, sign them, and bring them with you to your first appointment. The Patient Registration Packet  will be emailed to you after you schedule your first appointment. Please contact us at 212-244-4520 if you have not received them and your appointment is the next day.  Also, please be sure to read our Privacy Policy below.  

To complete the forms, you will need your insurance information, any prescription medications you are currently taking and the address of your most recent physician(s). Please gather this infomation before starting. 

Pre-Travel Health Consultation & Travel Vaccination Registration Form

If you are traveling outstide of the US and are interested in getting vaccinations, you will need to complete the Pre-Travel Health Consultation and Travel Vaccination Registration Form.  After you have scheduled your appointment, this form will be emailed to you.   Please contact us at 212-244-4520 if you have  not received your forms and your appointment is within one business day. 

If you need to request medical records from your previous physician, you can use this form.  You should complete the form and send it to your previous physician. You should also send one to other physicians currently treating you so that we can become up-to-date on your total health status.

OFFICE  POLICIES

Please review, sign and date our office policies and our financial policy statement..  We want you to understand our policies so that it will be easier to provide services to you.

PRIVACY POLICY

Please be sure to read our privacy policy below.