Patient forms

New Patient Intake Forms
Accountable Care OrganizationDOWNLOAD
Non-Participating Disclosure & Consent (English)DOWNLOAD
Non-Participating Disclosure & Consent (Español)DOWNLOAD
NYS Out-of-Network Surprise Medical BillDOWNLOAD
Authorization for Release of Health InformationDOWNLOAD
Lumbar Patient Form
New Patient Lumbar FormDOWNLOAD
Cervical Patient Form
New Patient Cervical FormDOWNLOAD
Physical Therapy Forms
Back IndexDOWNLOAD
Lower ExtremityDOWNLOAD
NeckDOWNLOAD
Shoulder/ArmDOWNLOAD
Symptom & Pain Scale: Please complete in addition to your condition formDOWNLOAD

Notice of Privacy Practices

This notice describes how medical information about you may be used and disclosed and how you can get access to this information.

For more information, please visit Columbia University Medical Center’s Health Insurance Portability & Accountability Act (HIPAA) Information page.

HIPAA Media Consent Forms
CUMC Media Consent FormDOWNLOAD
Neurological Associates Media Consent FormDOWNLOAD
NYP Media Consent FormDOWNLOAD
Email Communication
Email Communication FormDOWNLOAD
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