New Patient Forms

Our new forms can be filled out on line and then printed, prior to coming into our office,
you may need to open the form in Adobe Reader or Internet Explorer to be able to fill out the forms.

No-Fault Patients Only

New No-Fault Patient Form

Application for Benefits

Verification of Treatment (Only line 21 needs to be signed)

Assignment of Benefits

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Lynbrook Chiropractor Dr David Hecht DC, specializing in pediatric chiropractic and pregnancy chiropractic, serving the Nassau county New York communities of Lynbrook, Oceanside, Rockville Centre, Island Park, Long Beach, East Rockaway, Bellmore, Freeport, Baldwin and Valley Stream