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For Patients

We participate with most insurances, please call our office for more information.

List of insurances we participate in:

Please do not hesitate to contact us if you have any questions regarding participation.

 

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Medical Records Request

You can request a copy of your health information by completing a Medical Records Request and Authorization for Disclosure of Health Information Forms and submitting them to South Shore Neurologic Associates, PC. You can submit this form to the appropriate representative by mail, fax or in person.

South Shore Neurologic Associates, PC
Attn: Medical Records Department
77 Medford Avenue
Patchogue, NY 11772
Phone: 631-758-1910 ext. 2120
Fax: 631-758-1984

If you are submitting your request in person, you may do so from 8:30 a.m. to 4 p.m. at our Patchogue Office.

Please allow a minimum of 7-10 business days for forms to be processed and a minimum of 14 business days for requests for records

The Medical Records Department of South Shore Neurologic Associates, PC handles all Disability Forms, Physicians' Statements, and other paperwork, which you request your doctor to complete. Your physician will review not only each form but also your medical records before completing the required information.

Please complete the patient information section entirely and provide any pertinent information to avoid processing delays.

The fee schedule for forms is as follows:

• One Page Form $15.00
• Two Page Form $30.00
• Three Page Form $50.00
• Four Page Form $100.00
• FMLA/Attending Physician Statement $25.00

Payment must be made prior to the release of records or forms

 

Services

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