Sisselman Medical Group

MASSAPEQUA
ph.516-308-4040
fx.516-804-6386
627 Broadway, Suite 1
Massapequa, NY 11758
directions | hours of operation

COMMACK
ph.631-670-6525
fx.631-670-6526
2171 Jericho Turnpike, Suite 304
Commack, NY 11725
directions | hours of operation









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SISSELMAN MEDICAL GROUP NEW
PATIENT INFORMATION


You may download, print and complete our New Patient Registration Packet prior to your initial visit. Please be sure to read and complete all documents in full. To expedite your waiting time in the office, you may fax your completed forms to us at 516-804-6386 for Massapequa and 631-670-6526 for Commack. However, if you prefer, you may bring the completed forms in with you to your appointment. You may download Adobe Reader to view these documents here.


If your appointment is the result of a job related Workers' Compensation case, please print and complete the Workers' Compensation Information Forms. Please print these forms and fax the completed forms to us at the above fax numbers or bring them with you to your appointment.


If your appointment is the result of an automobile accident, please print and complete the No Fault Information Forms in addition to the forms above. Please print these forms and fax the completed forms to us at the above fax numbers or bring them with you to your appointment.



IMPORTANT NEW PATIENT INFORMATION


Please bring the following when you come for your first visit:


All forms you have completed at home. If you are unable to complete the forms, please arrive 15 minutes prior to your scheduled appointment so that we may assist you.


You must bring your health insurance card(s) with you and photo ID.


If your visit is due to an accident, such as Workers' Compensation or No Fault claim, it is important that we have all insurance information at the time of your visit. If you can not provide this information, you will be responsible for payment at the time of your visit.


All fees and co-payments are due at the time of service. Please refer to your insurance plan on what charges are covered. Any charges that are not covered are the patient's responsibility and are payable at the time of service. Payments are acceptable in cash or by check or credit card. Credit cards accepted here are: Visa, MasterCard, American Express.





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MASSAPEQUA
627 Broadway, Suite 1
Massapequa, NY 11758
directions | hours of operation
COMMACK
2171 Jericho Turnpike, Suite 304
Commack, NY 11725
directions | hours of operation