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).


You may return the downloaded  forms  by:

Fax: 315 637 0605  or

Regular snail mail:

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