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 email@example.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
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:
- Please Download New Patient registration packet
Please print and fill out these forms prior to your first office consultation. NOTE: Please be patient and make sure the entire form has downloaded before you hit the Print command in your browser. Printing too quickly will cause the first page to be missing from the printed document. In addition to this packet, additional forms may be required. Please see the list below & print these forms necessary for your visit.
- Pain Diagram
This form must be filled out completely for every visit. You must complete the form on the day of your visit for up to date information and accuracy on your pain level.
- Workers' Compensation form
If your appointment is due to an injury at work, please print and fill out this form prior to your consultation.
- No Fault form
If your appointment is due to an auto accident, please print and fill out this form prior to your consultation.
- Download Scoliosis Patient registration form
Please print and fill out this form prior to your first scoliosis office consultation. Note: This must be filled out in addition to the New Patient Form above.
- 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). Long Island Spine Specialists, P.C. complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.
- Patient Portal
Access to the patient portal is available after your first visit. The patient portal will give you online secure access to your medical records, ability to request prescriptions, request physcial therapy renwals or ask a question. Click button below for more information.