Dr. Amit Rajani

Patient Forms

Save time waiting in our office by filling out necessary forms online. Feel free to give us a call if you have any questions.

New Patient Packet - English

New Patient Packet - Spanish

Page 1: Contact Information and Insurance (English)

Page 2-3: Dental and Medical History (English)

Page 4: Financial and Cancellation Policies (English)

Page 5: HIPAA and Consent Form (English)

Page 1: Contact Information and Insurance (Spanish)

Page 2-3: Dental and Medical History (Spanish)

Page 4: Financial and Cancellation Policies (Spanish)

Page 5: HIPAA and Consent Form (Spanish)

Have Questions? Get in Touch
If you have difficulty using our website, please email us or call us at (845) 669-6638
View the ADA Accessibility Statement
COVID-19 UPDATE: THE OFFICE IS CURRENTLY OPEN TO EMERGENCIES ONLY BY APPOINTMENT. VIRTUAL CONSULTATIONS ARE AVAILABLE TO AVOID IN-OFFICE VISITS! PLEASE CALL US AT 914-423-1900 FOR MORE INFORMATION. THANK YOU AND STAY SAFE!

For more info about our COVID-19 response, watch this video  or schedule a virtual consult here.