Patient Forms

/Patient Forms
Patient Forms2023-11-07T20:56:38+00:00

Street Address:
1383 Veterans Memorial Highway,
Suite 36, Hauppauge, NY 11788

Telephone:  631.582.0088

Patient Forms to Download at The Therapy SPOT

The following forms are used by The Therapy SPOT to help our clients complete their registration needs.

Either click on the links to open the documents on your computer then print it out and complete it, or right-click the links and “save target as” to your computer where you can print it at your leisure.

When filled out either mail the form to us or bring it into the office on your next visit. Thanks from all of us at The Therapy SPOT!

Notice of Advice and Financial Agreement
Notice of Privacy Practices (Child) – HIPAA
Notice of Privacy Practices (Adult) – HIPAA
Welcome Release
My Health Record
HCFA Insurance Form 1500-90
24 Hour Appointment Cancellation Policy
Patient Consent To Use Email