New Client Forms

Please scan or fax insurance cards front & back to linda.bejoian@gmail.com or (212) 861-7801

INSURANCE QUESTIONNAIRE

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PAYMENT POLICY

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CHILD INTAKE FORM

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ADULT INTAKE FORM

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PATIENT CONSENT FOR RELEASE OF INFORMATION

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CANCELLATION AND MISSED APPOINTMENT AGREEMENT

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COPAY PROMISSORY AGREEMENT

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CREDIT CARD AUTHORIZATION

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CREDIT CARD ON FILE PROGRAM LETTER

COPAY PROMISSARY AGREEMENT

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