Forms & Consents
Complete your forms online from any device, or download a printable PDF to fill out by hand and bring to your appointment.
Complete Online
Sign digitally and submit from any phone or computer — no printer needed. A PDF copy is emailed to you automatically.
Annual / biennial renewal
Existing Patient Update
HIPAA, Opioid Treatment Agreement, Opioid Risk Tool (ORT), and Oswestry Disability Index — no full intake needed.
Platelet Rich Plasma
PRP Consent
Authorize your PRP procedure with Dr. Rubin. Covers diagnosis, risks, off-label status, and patient acknowledgments.
Infusion Therapy
Ketamine Infusion Consent
Informed consent for ketamine infusion therapy — risks, side effects, 16-point patient acknowledgments, and treatment schedule.
Consultation Consent
Peptide Therapy Consent
Educational consultation consent — experimental status, patient autonomy, and direct pharmacy relationship disclosure.
Print & Sign by Hand
Prefer paper? Download the form, print it, fill it out by hand, and bring it to your appointment. Forms are formatted for easy handwriting.
Annual / biennial renewal
Existing Patient Update
~9 pages · PDF · Fill by hand · Bring to appointment
Download PDFPlatelet Rich Plasma
PRP Consent
~2 pages · PDF · Fill by hand · Bring to appointment
Download PDFInfusion Therapy
Ketamine Infusion Consent
~3 pages · PDF · Fill by hand · Bring to appointment
Download PDFConsultation Consent
Peptide Therapy Consent
~2 pages · PDF · Fill by hand · Bring to appointment
Download PDFPDFs open in your browser or download directly — formatted for standard 8.5" × 11" paper.
Questions?
If you're unsure which form to complete, call our office and a team member will guide you.
516-492-3100·Mon–Fri, 9am–5pm ET