587 5th Avenue, New York, NY, USA, Suite 802
P: (212) 249-1600 | F: (212) 288-0809
P: (212) 249-1600 | F: (212) 288-0809
You can submit the paperwork electronically or by printing out the PDF and emailing it back to us (staff@fieve.com) upon completion.
Please include supporting pictures:
1. photo ID
2. FRONT AND BACK of insurance card
3. FRONT AND BACK of credit card you would like to put on file for payments
After we verify all of your information, we will contact you to set up your initial appointment. Please keep in mind scheduling and verification depend on when we receive your completed information. Your appointment request is not confirmed until we call you for scheduling.
WE CANNOT PRESCRIBE CERTAIN MEDICATIONS WITHOUT HAVING YOUR MOST RECENT PHYSICAL EXAM, LABS AND EKG FROM WITHIN A YEAR ON FILE.
LABS MUST INCLUDE:
Please be prepared to pay for copay’s, co-insurance, or patient responsibilities as determined by your insurance at the time of service. If paying with a card, there is a 3% processing fee.
Finally please make sure to give at least 24hours notice if you need to change, reschedule or cancel any appointments or your credit card on file will be charged $350.00 for missing your appointment. Messages can be left on our time stamped voicemail, text, or by email.
You can complete the forms and upload the necessary documents online via the button link below.
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