New Patient

Become A New Patient

All Forms are responded to in 24 hours or Same Day During Our Hours of Operation

Monday through Friday 9am-7pm

Patient Name

Date of Birth

Phone Number
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Your address

City

Province

Zip/Postal Code

Reason for Treatment:

Payment Type (Select)

Private Pay Per Visit Insurance

Please Note: We Do Not Pursue any Disability Claims and We Do Not Perform Therapy only Medication Management Evaluations. All New Patients are Reviewed for Insurance Eligibility. Patients Consent to Authorizing the Practice to Review any Medications on New York State Prescription Monitoring Program and We Have a Right to Refuse any Patient on Controlled Substances without a Clinically Legitimate Use as Determined by Clinicians. *

Start Your Journey

Become A New Patient

Book an
Appointment Today

New Patient

Start Your Journey

Become A New Patient

Book an Appointment Today

Book an
Appointment Today