Patient Forms

We want your registration experience to go as smoothly as possible. Before receiving care as a Joseph P. Addabbo Family Health Center patient, we ask that you fill out several patient registration forms, which will ensure compliance with HIPAA policies and ensure that you understand your rights and responsibilities. Please review these documents prior to your visit.

You can fill out the forms online, print them out and bring the completed forms with you to your first visit. Or you can print out the forms, fill them out manually and bring the completed forms to your first visit. This will expedite your registration process.

In addition to the registration forms, please bring the following information/documentation with you to present to the registrar:

  • Photo ID
  • Insurance card
  • Proof of income for self-pay patients/patients without insurance
  • Referral for specialist
  • Social Security card
  • If you are not working, a notarized letter of support is required.
  • Biological parent or legal guardian must accompany the child at initial visit.
  • Proof of guardianship if you are not the parent
  • Birth certificate or passport for the child
  • Immunization records
  • Insurance information for the child
  • Photo ID of biological parent or legal guardian
  • Proof of address (driver’s license, utility bill)
  • Proof of income for patients without insurance

Patient Registration Forms

  • Notice of Privacy Practices for Protected Health Information

We welcome patients from Brooklyn, Jamaica, Queens, Far Rockaway, Arverne, Red Hook, Rockaway, Ozone Park, Inwood, Long Island and nearby locations. Please call 718.945.7150 or use our online form to request an appointment.

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