|135 Spring Street, 2nd Fl • NYC 10012
Tel. 212.219.1187 • Fax 212.219.1538
Link to Our Patient Portal: (AthenaHealth Patient Portal)
Forms:IF YOU ARE UNABLE TO LOG INTO THE PATIENT PORTAL PLEASE USE THE LINKS BELOW TO COMPLETE THE FORMS AND FAX OR BRING THEM WITH YOU DURING YOUR NEXT VISIT.
PLEASE NOTE THAT IT CAN TAKE UPTO 5 BUSINESS DAYS TO PROCESS PAPER FORMS.
Link to Patient Registration Form: (Patient Registration Form)
Link to Outging Records Release Form: (Outgoing Record Release Form)
Link to Incoming Records Release Form: (Incoming Record Release Form)
Link to Office Financial Policy & Agreement: (Office Financial Policy)
Link to Global Maternity Financial Policy: (Global Maternity Financial Policy)
Link to HIPAA & Privacy Form: (HIPAA & Privacy Form)
Link to NYULMC HIE Patient Consent Form: (NYU HIE FORM)
NYU Medical Center Information
We are affiliated with NYU Medical Center, Tisch Hospital in mid-town Manhattan.
NYU Contact Info:
FLAGG, MD BRINA MALDONADO, MD DANIELLE FELDMAN, MD • LINDA CHO, MD • ELIZABETH RODGERS, MD • LEIGH ANN WADE, MD KATHRYN KEATY, MD VICTORIA ONBREYT, MD
BONNIE YIM, CNM LAUREN LESE, CNM MARY MILLER, CGC
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