(212) 599-4400

New Patient Forms

Are you a new patient? Sean O. Henry, MDs staff is friendly and always ready to help with scheduling, insurance or anything else you may need during your time with us. Please check-in at the receptionist desk when you arrive for your appointment. For your first visit to our Midtown, NYC office, please arrive approximately 10 minutes before your appointment to fill out patient intake forms or simply print the attached forms and complete them and bring them to your first visit. We will also need information about your insurance coverage and medications. Please bring your insurance card and driver’s license with you to every appointment. Should you have any information change please let us know so we can update your records. Please print out the following forms and fill out before your next visit. 

» Patient Registration   
» Credit Card Form
» Notice of Office Procedures
» Notice of Privacy Practices
» Patient HIPPA Awareness
» Fee Schedule (For new pregnancies only)
» Preferred Pharmacy Information Form

 

For more information or to schedule an OBGYN( Gynecologist or Obstetrician)  consultation please feel free to contact Sean O. Henry, MD of NYC today by phoning (212) 599-4400.

Sean O. Henry, MD
800A 5th Avenue, suite 503
New York, NY 10065