Patient Information
Please note that you will receive a text and email three days prior to your appointment from Phreesia, prompting you to complete your new patient registration packet. If for any reason you can't complete forms electronically, please complete and print the forms provided below to bring to your appointment.
If you cannot do either, please arrive 15 minutes prior to your appointment to complete the paperwork.
Your options are:
- Complete new patient registration forms via Phreesia
- Print and complete the forms listed below
- Using Adobe Acrobat Reader, download, fill in and print the forms below
- Request the forms to be mailed to your home
Patient Forms:
Additional Forms:
Telehealth Services
At NAD Medical Services, your health and safety are our top priorities. We continue to monitor the COVID-19 outbreak and are taking all the necessary precautions to ensure everyone's safety.
In response to this, we have added a Telehealth service to our practice so we can continue to serve your medical needs during this time.
Our platform is HIPAA secure and your physician can conduct your exam in a safe, virtual environment. Please call us at (631) 749-5910 to schedule your Telehealth visit.
To learn more about how to prepare and what to expect from your appointment visit:
www.stonybrookmedicine.edu/patientcare/telehealth/your_telehealth_visit
Good Faith Estimate
If you are uninsured, you have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost.
Under the law, healthcare providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.
- You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
- Make sure your healthcare provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
- If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
- Make sure to save a copy or picture of your Good Faith Estimate.
For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call our office.
Insurance
NAD Medical Services at Peconic Landing currently works with over 30 major insurance companies. Our staff is always working on accommodating our patients and their insurance providers. Please call our office at (631) 749-5910 to find out if your carrier is on our continuously expanding list of providers.
- 1199SEIU National Benefit Fund (through Aetna Health Plans)
- Aetna Health Inc.
- Affinity Molina/Medicaid, Child Health Plus
- Affinity/Molina Medicaid
- AgeWell New York Plans
- Beech Street, a MultiPlan Network
- MagnaCare PPO /Direct Plus (Brighten Health Plan)
- Magnacare Northwell Direct (wrap-around network)
- CenterLight Healthcare
- Cigna HealthCare of New York HMO, PPO, Open Access
- Emblem Health-Somos
- EmblemHealth Plan, Inc., (GHI)
- Healthcare Partners (Specialists only)
- Emblemhealth Plan (HIP)
- Empire HealthChoice HMO, Inc.-Prefixes - R4R, ZTO, PYO, S8Q, KCH, YXF, AZL, J2H, C4D, YKH, HPP, D9U, PTQ, EQV, VRH, VYW, L4P
- Empire HealthChoice HMO, Inc.-Federal Employee Program (Prefix R)
- Empire HealthChoice HMO, Inc.-EmpireBlue _ Northwell Direct Tier 2
- Empire HealthChoice HMO, Inc.-Blue Cross Blue Shield Global Core
- Empire Blue Cross (confirm plan with Empireblue.com)
- Empire Individual Network (Gatekeeper) (Prefix VFG, VJD)
- Empire Medicare Advantage HMO Plans (not Select Plans)
- Empire BlueCross BlueShield HealthPlus Medicaid/ Child Health Plus (Prefix JLJ)
- Empire Plan, the New York State Health Insurance Program (NYSHIP)
- Excellus Health Plan, Inc.
- Fidelis Medicaid, Child Health Plus, HealthierLife
- Healthfirst Medicaid, Child Health Plus, Essential, Personal Wellness
- Humana ChoiceCare Plans as a Wrap-Around GHI Network Access
- Humana TriCare
- MultiPlan PPO/PHCS/Limited Plan
- Oxford Freedom
- Oxford Liberty
- Partners Health Plan
- UnitedHealthcare Community Plan-Medicaid, Child Health Plus, Wellness4Me
- UnitedHealthcare Community Plan-Essential Plan Program
- UnitedHealthcare of New York, Inc.-All Savers
- UnitedHealthcare of New York, Inc.-Bind Health Insurance
- UnitedHealthcare of New York, Inc.-Choice Plans
- UnitedHealthcare of New York, Inc.-Compass Plans
- UnitedHealthcare of New York, Inc.-Doctors Plan
- UnitedHealthcare of New York, Inc.-The Empire Plan/NYSHIP
- UnitedHealthcare of New York, Inc.-Heritage Plans
- UnitedHealthcare of New York, Inc.-Navigate Plans
- UnitedHealthcare of New York, Inc.-NexusACO Tier 1
- UnitedHealthcare of New York, Inc.-Options Plans
- UnitedHealthcare of New York, Inc.-Passport Connect Choice Plans
- UnitedHealthcare of New York, Inc.-Select Plans
- UnitedHealthcare of New York, Inc.-Signature Value Plans
- UnitedHealthcare of New York, Inc.-W500 Emergent Wrap
- UnitedHealthcare Nursing Home Plan 1 (PPO I-SNP)
- United Healthcare Assisted Living Plan (PPO I-SNP)
- VA Community Care Network
**Disclaimer**
Insurance plan participation may change over time. While every effort is made to ensure the accuracy of this information, we recommend that you confirm participation status with your insurance carrier or practice. Please note that insurance plan participation requirements may be waived when a patient receives medical treatment in an emergency.