Patient Resources
Patient forms and office policies, in one place. Confirm current documents and instructions with the practice before your visit.
Forms
Blank patient forms for download. Confirm the appropriate version with the practice before completing a form.
Patient information stays off this pageThis is a document directory, not an online intake form. Do not submit completed forms, medical records or insurance details here.
Policies
Please review our Office Policies.
Initial Consultations
Your referring physician must fax us a referral, results of pertinent studies (i.e. MRI, EMG) and previous care to our office. If we do not receive this information in a timely manner, it will delay your care or we may need to reschedule your appointment.New York Spine & Sport Rehabilitation Medicine Office Fax: 718.794.9899
Please complete out the appropriate
New Patient Information from our website.
New Patients Information Form | Download
New Patient Information for Work Related Injury Form | Download
New Patient Information for Motor Vehicle Accident Form | Download
You may fax or email this information with a copy of your insurance card prior to your appointment or bring the completed forms and your insurance card the day of your appointment.If your pain is related to a work related injury or a motor vehicle accident please provide us with the assigned case number and required info as per the particular New Patient information sheet. Please do not use your medical insurance if your pain/injury is related to a reported work related injury or motor vehicle accident.
Authorizations
If your insurance requires prior authorization for a visit to a specialist, you must arrange for this and obtain the authorization number prior to your visit.
Payment Policy
Insurance co-payments are due at the time of arrival. We accept cash, checks, and credit cards.
Insurance
We accept most insurance programs and their subsidiaries. If we do not participate in your insurance plan, please speak to Lori our Office Manager who will check if other arrangements are possible.
Appointment Cancellation & Rescheduling
Unfortunately, we cannot accept walk-in patients. If you are a new patient, please arrive 15 minutes prior to your scheduled appointment time to allow time to register.
Medication & Refill Requests
Our practice does not prescribe narcotic medications only, we use a multi-adjuvant combination of non narcotic medications, interventional procedures, physical therapy and combination therapies such as psychological or nutrition management to control your pain condition. Please discuss your medication needs, including refill requests, with our physicians at the time of your appointment. Medications should be taken only as prescribed, if opiates are prescribed by practice you may need to sign an Opiate Contract.
Please do not request early refills of your medications. Patients are responsible for lost or stolen medications and prescriptions once they leave the office. Please do not call the office for a medication refill.
Procedures
If you are scheduled for an interventional procedure, please read the procedure information carefully and bring a designated driver to transport you home. If you are unable to arrange for a driver please let our know in advance.
Referral Sheet
If you are a referring doctor please use our referral sheet. Please clearly mark and fax (we prefer fax) or send this referral sheet with the patient.
After Hour Emergencies
After regular hours, if you have a medical emergency please call 911. If you undergone a interventional procedure or need to contact Dr. Sireen Gopal or Dr. Bryan Elzholz after work hours for an emergency only, please call the Jack D Weiler Hospital Operator @718.904.2000 who can arrange to transfer your call to our staff
Billing Inquiries
A practical next step
Start with the right team.
For general appointment questions, contact the practice team. Existing patients should use the Patient Portal rather than send health information through a general email.