Downloadable Forms


The Spine Institute of New York provides the following office documents for your access online. You will need the free Adobe Acrobat Reader to view and print these documents. If you do not have it you may download and install it for free by clicking here.

Forms Required For All New Patients

New Patient Registration Form

All new patients with appointments should complete this form and bring to your initial visit to provide us with information about insurance coverage.

Forms Required For Some New Patients

Worker’s Compensation Form | No Fault Registration Form

Patients covered by workmen’s compensation or no fault, please complete this additional form prior to your office visit.

Other Forms

Medical Records & Films Release Form

Use this form to authorize The Spine Institute of New York to release medical information or requesting access to medical records.

Surgical Patients: Pre-surgical Packet

This pre-surgical packet has instructions on what preparing for surgeries, medications to discontinue, what to expect on day of surgery as well as post-operative instructions.

Surgical Patients: Post-operative Questionnaires

When you come for follow-up, we will ask you to fill out questionnaires on your health (except at the 10-day follow-up). Please take the time to fill those out. Your answers are used for monitoring of your health and quality assurance. You may also fill out the questionnaires at home before your visit and bring them to us:

  • If your cervical spine (neck) is operated, please fill out the following questionnaires.
  • If you have been diagnosed with scoliosis or kyphosis, please fill out the following questionnaires.
  • If you are operated on because you suffer from low back pain and you are NOT diagnosed with scoliosis orkyphosis, please fill out the following questionnaires.


Contact Our Office

Beth Israel Medical Center
10 Union Square East | Suite 5P
New York, NY 10003

Phone: (212) 844-8680
Fax: (212) 844-8681

Office Hours

Office Open:
Monday-Friday, 8am-5pm

Telephones are answered:
Monday-Friday, 9am-4pm
*Excluding holidays

Patient Education

Watch our patient education videos to learn more about spinal conditions and procedures.

 Conditions & Diagnosis
 Treatment Options