New Patient Forms

All new patients, please complete the following forms prior to your appointment. You can print and email or bring them with you to your appointment. Failure to complete forms beforehand may decrease allotted assessment and treatment time.

1. New Patient Health Form

2. HIPAA & Financial Policy Form

4. Consent Form

3. Insurance Verification

4. Insurance Agreement Forms

If upon completing the forms, there are questions or concerns, please call prior to your appointment time.

Phone: (646) 854-6619

Monday-Sunday 8am to 8pm
By appointment only

Forms - Linyana Gipson, L.Ac. in Upper West Side, Manhattan, NY 10024

107 W. 82nd St, Ste 108
New York, NY 10024
(Btwn Columbus & Amsterdam)