We want to help you get ready for your first visit so that Dr. Weinberg can have as much information as possible to provide you with the care you need in the most efficient manner. Make sure you bring your primary care physician’s referral (if required), recent laboratory reports, scans, and other relevant procedure results. Please remember to bring your insurance card and photo ID.
For your convenience, please download the PDF forms located in the “Patient Forms” tab above. Please fill out, print, and bring the forms to your first visit. Thank you.
Click on a link below to download/print the form you need
New Patient Information Sheet
Medical History (2 Pages)
Records Release Forms
Insurance Payment Authorization
HIPAA Consent Form
AETNA HMO
AETNA INDEMNITY
AETNA MEDICARE
AETNA POS
AETNA PPO
Cigna HMO/POS
Cigna PPO
HEALTHNET HMO
HEALTHNET PPO
HIP ACCESS I
HIP ACCESS II
HIP CHLD HLTH
HIP EPO/PPO
HIP FAM HLTH
HIP HMO
HIP MEDICARE
HIP POS
Oxford Freedom
UHC EPO
UHC HMO
UHC POS
UHC PPO
UHC TOP TIER
UPN Elite
Insurance Disclaimer: Please confirm prior to each visit that an insurance listed above is still accepted at the office. The information presented here may not be complete or may have changed.