Podiatric Patient Forms

Download Patient Forms

To speed up your visit to our office, you may print out these forms (in pdf format) and complete them at your convenience. Please bring your completed forms with you when you visit our office.

FOR NEW PATIENTS:  Choose the 5-page New Patient Information Form

FOR EXISTING PATIENTS: Choose the  3-page Patient Update Form

WORKERS COMP FORMS:  Worker's Comp patients who are new must also fill out the New Patients forms.

Please Note: Worker's Comp patients who are new to this office must fill out both the New Patient Forms and the Workers Comp Forms.

For New Patients (pdf)


For Existing Patients (pdf)


Workers Comp Forms (pdf)


Lance Berlin, D.P.M., Podiatric Medicine and Surgery

Please  call us for an appointment.
Fax any documents to 631-277-0298.

Dr. Lance Berlin, Podiatrist

Union Medical Plaza, 2330 Union Boulevard, Islip, NY 11751, USA

(631) 277-8900 Fax: 631-277-0298 Email: lanceberlin@gmail.com Web: www.lanceberlin.com

Office Hours

Open today

08:00 am – 08:00 pm

Open 7 days a week.

24 Hour Emergency Service Available.