Before you book an appointment, you will need to provide proof of one of the 12 qualifying conditions and one proof of New York State residency. You can do so easily with our secure upload form below. Alternatively, you may fax the required documents to us at 212-784-6896.

PROOF OF RESIDENCY

You only need ONE of the following:

  1.  A New York State Driver’s License or New York State Identification Card. (New York City ID is not an acceptable form of identification.) 
  2.  A copy of a utility bill (i.e: Electricity Bill, Cable Bill, Internet Bill) indicating an applicant’s current residency (MUST contain applicants name and address listed. The bills should back track two months.)
  3.  A copy of current lease indicating an applicant’s residency within New York State.

*Temporary residents must provide ID and proof of residency such as lease or utility bill.

PROOF OF QUALIFYING CONDITION(S)

You only need ONE of the following:

  1. A copy of your medical documents/records  
  2. A medical note from your physician stating your diagnoses

*If you suffer from chronic pain you will need additional information. Your medical diagnosis or medical letter from your physician must state that you have had pain or anticipate that you will have pain longer than 3 months. It must state that you have tried other treatment options that have failed (i.e. tried pain medication, surgery or other treatments).

 

hippa badge.png

***Having trouble uploading documents? Alternatively, you may fax the required documents to us at 212-784-6896.