Important Forms

New York State and Chiropractic Forms
Staten Island, New York

To best serve you we provide all of our forms online in PDF format for you to easily print from your home or office. At Touchstone Rehab we believe in performing our healing practices to the letter of the law and with your best interest first. Below you will find forms for:

- Workman’s Compensation
- NY Motor Vehicle No-Fault App for Benefits
- NY Motor Vehicle No-Fault Assignment of Benefit
- Chiropractic Registration and History
- Insurance Financial Agreement
- Individual Patients Authorization
- Notice of Privacy Practices & Acknowledgement
- Confidential Patient Information
- Attorney Information
- X-Ray Authorization
- Authorization for Release of Health Information HIPAA

Insurance Financial Agreement
Very important form to assist you the client.

Individual Patients Authorization
One page front and back

Notice of Privacy Practices & Acknowledgement
Five pages total

Confidential Patient Information
One page total

X-Ray Authorization
One page total

Authorization for Release of Health Information
One page total pursuant to HIPAA

Slip & Fall
Auto Accidents
Neck / Back Pain
Sprains & Strains
Pain Management
Soft Tissue Injuries
Wellness Programs
Workers Compensation
Vitamin / Nutrition Therapy

Dr. Angelo DiMaggio to specializes in providing sale and affordable Chriropractic Care to people of all ages. We have been able to succesfully treat patients with stunning success for conditions ranging from whiplash to Scolosis to Carpal Tunel Syndrome.