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X-Ray Interview

Registration for Patients with:
-Private Insurance, Medicaid, Medicare or Medigap
-No-Fault insurance or Workers Compensation

Assignment of Benefits for Patients with No Fault Only

Medical Records Release

Authorization to Obtain Medical Records

HIPAA Policy & Acknowledgement

All forms are in Adobe Acrobat.
Click Here to get the reader if you don't already have it.

 

 

phone: 845-340-4500 • fax: 845-340-4501

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