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Lance Berlin, DPM

(631) 277-8900

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(631) 277-8900

Lance Berlin, DPM
  • Home
  • Services
    • Podiatric Services
    • Swift Wart Treatment
  • About Us
    • The Podiatrists
    • Insurance
    • Hospitals
  • Patient Forms
  • Products
  • Contact Us

Podiatric Patient Forms

New or Existing Patient Forms: Use our Secure Online Forms Portal

If you have an authorization code from our office, you can use that code to access our online Secure Forms Portal to complete your patient forms. 


NOTE: The Online Forms Portal only has forms for New and Existing Patients. If you need to access the Worker's Comp forms, please use the pdf file link at the bottom of this page.

Secure Forms Portal

OR You can Complete Patient Forms as PDF files

To speed up your visit to our office, you may print out these forms (in pdf format) and complete them at your convenience by clicking on the Download links below. 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 and Existing Patients (pdf)

Download

For Existing Patients (pdf)

Download

Workers Comp Forms (pdf)

Download

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

08:30 am – 08:30 pm

Open 7 days a week.

24 Hour Emergency Service Available.


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