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New Patient Forms
On this page you will find printable forms for New Insurance and New Cosmetic Patients. To enhance your experience and make the entire process as smooth as possible, please fill out these forms prior to your consultation and email them back to info@harrisplasticsurgery.com.
Forms for New Insurance Patients
- New Patient Form
- History and Physical
- Out of Network Disclosure Law
- Assignment of Benefits
- NY Emergency Medical Services
- Member Authorization Form for a Designated Representative to Appeal a Determination
- Protected Health Info Authorization
- Consent to Use Protected Health Info Authorization
- Non-Medicare Authorization
- Notice of Privacy Practices