New Client Forms

If you are a new patient please download and print the New Client forms below:

After reviewing its content, fill out , sign and return, before your first appointment.

For the red insurance authorization form (CMS1500) , there is no need to fill it all out. Just sign without dating box 12 (by the client) and box 13 (by the policy holder).

Send forms via:

Fax: 315 637 5009

Email: mheath1@twcny.rr.com

or regular snail mail:

Rev. Michael Heath
7913 East Ridge Point Drive
Fayetteville , New York 13066