Online Forms

New York Chiropractic Associates offers our patient forms online, so you can complete them in the convenience of your own home or office.

  • If you do not already have AdobeReaderĀ® installed on your computer, Click Here to download.
  • Download the necessary form(s), print it out and fill in the required information.
  • Fax us your printed and completed form(s) to 212-861-4769 or bring it with you to your appointment.


Required for New Patients

Patient Health Record

Office Policy

Required for Former Patients

Update Form


Insurance Paperwork

Required for Oxford, United Health Care, and Aetna plans managed by ACN

**Please fill out the bottom portion of the patient summary form**

Patient Summary

Neck Index

Back Index

Required for BCBS and Cigna plans managed by American Specialty Health Network (ASHN)

Initial Health Status

Patient Progress

Office Hours

Monday:

7:45 am

6:00 pm

Tuesday:

1:00 pm

6:00 pm

Wednesday:

7:45 am

6:00 pm

Thursday:

1:00 pm

6:00 pm

Friday:

7:45 am

1:00 pm

Saturday:

Shabbat

Shalom

Sunday:

Closed

Closed

Location

Find us on the map

Testimonials

Reviews By Our Satisfied Patients

  • "Dr. Gold is extremely caring, smart and a great chiropractor. I would highly recommend him to anyone interested in achieving improved function and better health!"
    Bradley R.
  • "This place is *amazing.* I had, no exaggeration, 8+ months of ongoing headaches. I had Neurologists trying to put me on medicines that I was petrified to even consider (anti-seizure ones, etc.); after 6-8 weeks here, my headaches have subsided and almost gone away completely. The doctors and staff are all very caring, thorough, and knowledgeable. This was the best decision I've made to come here."
    Jillian C.
  • "The whole office staff is amazing. I had severe back pain which prevented me from sleeping, and after a few visits I was so much better! I continue to come for adjustments to maintain my back. Thank... you for taking care of my back!"
    Ziv A.
  • "An amazing practice. The staff is friendly and efficient. Dr. Gold is wonderful. Caring, thorough, and knowledgeable. He really takes the time to understand your needs."
    Amy H.
  • "I have been a patient of Dr. Gold's for years, and have always had an exceptional experience. My pain and discomfort has decreased significantly since I began seeing him. Dr. Gold has a wonderful bedside manner, and I have found his staff to be accommodating, professional, and friendly at all times. I highly recommend this practice."
    Lori E.

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