I have been seeing Dr. Rubin for about two years and I can't begin to tell you the difference that he has made. I was…read more→
I was experiencing severe right sciatic pain, and a severe vice-like stabbing in my right calf, from multiple lumber herniated discs putting pressure on my…read more→
Dr Rubin has given me a new lease on life. He is patient, kind, and very understanding and he is a very good listener. But…read more→
I have been a patient of Dr. Rubin for the last two years. He is both an extremely competent pain management professional and a doctor…read more→
Below, you’ll find all the information and forms necessary for your first visit, and some reminders for returning patients. We look forward to seeing you at our offices for your upcoming visit.
Detailed information on office visit and procedure locations can be found on our “Contact Us” page.
BEFORE YOUR VISIT
- Contact any of your referring physicians for any previous records that pertain to your pain issues.
FOR YOUR VISIT
What to Bring
- Your insurance cards
- Photo ID
- Any updated diagnostics or medical information
- Completed medical forms – download forms below
- Most recent MRI, CT scans or x-rays with radiology reports
FORMS FOR NEW PATIENTS
In order to facilitate more convenient registration for appointments, all necessary new patient forms below are available for download. Please bring ALL the forms completed to save you time upon your visit.
If you are unable to download or fill out the forms prior to your visit, we will be happy to assist you in filling them out on your appointment day. If you need help filling out the forms in the office, please arrive 15 minutes earlier than your scheduled appointment time.
New Patient Medical Questionnaire – download pdf
New Patient Registration – download pdf
HIPAA Privacy Authorization – download pdf
Notice of HIPAA Privacy Practices – download pdf
Opioid Agreement – download pdf
This form outlines our strict policies and procedures as well as the patient’s responsibility in using narcotic medications appropriately.
Insurance Assignment of Benefits – download pdf
We currently participate in the following health plans:
- AETNA – HMO, INDEMNITY, MEDICARE, POS, PPO/EPO
- CIGNA – EPO/POS, PPO
- EMPIRE BCBS – EPO, HMO, INDEMNITY, MEDIBLUE, PATHWAYS / PATHWAYS ENHANCED, POS, PPO, TOP TIER
- BCBS ANTHEM
- HGI – CBP
- HIP – ACCESS I, ACCESS II, CHLD HLTH, EPO/PPO, HMO, MEDICARE, POS
- HUMANA MEDICARE
- LOCAL 1199 PPO
- MAGNACARE – PPO
- MULTIPLAN/ PHCS PPO
- NYS EMPIRE PLAN
- OXFORD – FREEDOM, LIBERTY, MEDICARE
- UNITED EMPIRE
- UNITED HEALTHCARE – EPO, HMO, POS,PPO, MEDICARE, TOP TIER
- If you do not see your Insurance plan,
please contact us!
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