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New Patient Application & Forms

Forms 

  • Practice Information

    • Payment Policy 

    • Cancellation Policy 

    • Insurance Policy 

  • Notice of Privacy Practices (HIPAA Consent Form) ​

  • Authorization for Release of Medical Records

Adverse Childhood Experiences Questionnaire 

Mental Health

Screening Form

Substance Use

History

Amino Acid Imbalance Questionnaire

Brain Body Medical


Contact Us:

Locations:

New York City, NY

15 East 40th Street, Suite 201

New York, NY 10016

Stamford, CT

680, E Main Street

Stamford, CT 06901

Disclaimer

This website and blog is for general health information only. This website is not to be used as a substitute for medical advice, diagnosis or treatment of any health condition or problem. Visitors and users of this website should not rely on the information provided on this website for their own health problems. Any questions regarding your own health should be addressed to your own physician or by reaching out to us.

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