NY Orthopedics Patient Forms

Save time at your appointment by filling out your patient forms ahead of your visit. Click on the links below to view and print forms. More patient forms can be found on our Patient Portal.

NEW PATIENT FORMS

• Dr. Stephen Nicholas – New Patient Form

• Dr. Benjamin Bedford – New Patient Form

• Dr. Firas Chamas – New Patient Form

• Dr. Sergai DeLaMora – New Patient Form

• Dr. Steven Lee – New Patient Form

• Dr. Matthew (Teo) Mendez – New Patient Form

• Dr. Nicholas Wessling – New Patient Form

• Dr. John Xethalis – New Patient Form

• Dr. Sameh Elguizaoui – New Patient Form

• Dr. Matthew Gotlin – New Patient Form

OTHER PATIENT FORMS

• Release of Patient Information Form – If you would like us to release your medical information to another provider, medical entity or individual, please print this form, fill it out and fax it or present it at your next appointment.

• Request Medical Records – Request your medical records through ChartRequest.

• HIPAA Notice of Privacy Practices

• No Fault or Accident Form

• Worker’s Compensation Form