Registration Forms

We are glad you have decided to come to our office for a consultation.  Please complete the following forms before your visit. 

1. Recent labs and blood work. If these are under 15 pages, you may fax them to us ahead of time at (914) 864-1967.
2. List of supplements and/or medications you are taking.
3. The following completed forms (Click here to download all forms as a single pdf)
   1. 3-Day Dietary Log, including all meals, snacks and beverages consumed (Download)
   2. Office Registration Form and Disclaimer (Download)
   3. Health Profile Questionnaire (Download)
   4. Health History (Download)
   5. HIPAA policy acknowledgment (Download)
   6. Pediatric Health Profile (kids only) (Download)
      

If you would like a copy of our complete HIPAA policy, please request it at your visit or download it here.

If you should need to contact us to change your appointment, please call (914) 864 - 1976. Please note that we have a 48 hour cancellation policy.  We will be happy to reschedule you with 48 hours notice, otherwise you will be charged for the appointment.  For any appointment canceled and not rescheduled, a $25 processing fee will be charged.