Thank you for entrusting your care to us

This page will provide you with all the necessary forms, as well as important information regarding your first visit. Please be sure to read and complete all documents.

In order to expedite your first visit, we request that you arrive 15 minutes prior to your appointment on your initial visit so all necessary paperwork can be processed and you are kept on schedule. If you are unable to keep your appointment, kindly notify us at 631-462-2225, press 4, or email appointments@lispine.com so we may accommodate another patient.

If you have any questions, do not hesitate to contact the office. We look forward to seeing you.


Long Island Spine Specialists, P.C. Staff

Digital Forms for Office Visit

The link below will redirect you to LISS' Secure Cloud Based New Patient Forms. Complete these forms more than 24 hours prior to your visit to minimize wait time.

Initial Patient Registration Forms (Click Here for Printable Version)

Print Form for Follow-Up Visit

Download the LISS Notice of Privacy Practices & Section 1557 of the ACA (Affordable Care Act)
This notice describes the privacy practices of Long Island Spine Specialists, PC and how Long Island Spine Specialists may use and disclose your protected health information (PHI).

First Visit: for New Patients

Please bring the following when you come for your first visit:

  • All prior medical information including x-rays, scans, MRIs and any accompanying medical reports. (Please bring copies of MRIs and scans on CD.)
  • Please complete all forms prior to your visit in order to expedite your first visit with us.
  • Please bring your health insurance card with you. We will need to scan the card into our computer system.
  • If your insurance requires a referral from your primary care physician, please call that physician for the referral number or bring your paper referral.
  • If your visit is due to an accident, such as a Workers' Compensation or No Fault claim, it is imperative that we have all insurance information prior to your appointment.
  • All fees and co-payments are due at the time of treatment. Please refer to your insurance plan or contract for information on what charges are covered. Any charges that are not covered are the patient's responsibility and are payable at the time of service. Payments are acceptable in cash or by check or credit card.
    Credit cards accepted here are:
"Thank you so much Dr. Basra for taking the time and patience to perform surgery and help make me get better, your hospitality is excellent. Dr. Basra isn’t just a doctor he takes the time to know his patients and he always has a smile and always has something uplifting and cheerful to say. Dr. Basra made me feel comfortable the first time I met him and that matters a lot to a patient when your concerned about your wellbeing. Dr. Basra is special and is full of kindness."

Melody M.

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