In order to comply with HIPA regulations in regards to patient privacy, a signature is required in order to properly submit the Review Intake Form. You need to download the International or Domestic form in one of its two formats:
     International Review Intake Form: Adobe Acrobat PDF or a Microsoft Word document
     Domestic Review Intake Form: Adobe Acrobat PDF or a Microsoft Word document
Fill it out, sign it and date it, and mail or fax it to us. If you would like to email a copy of the form to us prior to mailing/faxing it, please put your surname(s) in the SUBJECT of the email message (i.e. subject of email would be "Review Intake Form - Aronson"). Our mailing address is listed below, and our fax number is 212.207.6665.