Patient Forms

 

New Patient Form

New Patient Packet

Orthopedic Medical Records

Form E – Medical Records Release Form

Form F – Addendum Request Form

MRI Forms

MRI Pregnancy Consent

Gadolinium Consent

CT Questionnaire

Companion Questionnaire

MRI Screening Questionnaire

Physical Therapy Forms

Commercial New Patient

MCR New Patient

No Fault New Patient

Self Pay New Patient

WC New Patient

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Our offices across Long Island are open for in-person visits with new protocols for immediate, personalized care in the safest possible environment.

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How we helped our patients feel better.

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  • Ernest Giovelli
    "I had been working with pain in my left shoulder for almost two years because of worn cartilage. I tried ...

    Ernest Giovelli

    Procedure

    Left Shoulder Replacement

    Performed By

    Philip Schrank, M.D.

  • Raymond Stambouli
    "I wanted to take a moment to thank the staff, both in Massapequa and in Merrick, for helping me to rehab ...

    Raymond Stambouli

    Massapequa, Merrick

    Procedure

    Physical Therapy

    Performed By

  • John Modiest
    "I can’t say enough, Dr Germano is not only an excellent Surgeon and he cares very deeply for the well ...

    John Modiest

    Procedure

    Hip replacement

    Performed By

    James A. Germano, M.D.

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