Patient Forms

Referral Form (Download PDF)

A referral is required for all new patients. Please have your doctor complete this form and fax it to 203-624-4301.

New Patient Forms (Download PDF)

Please click on the button to download the new patient forms, print and complete them before your office visit. If you are seeing Dr. Robbins, please be sure to click on the “Dr. Robbins New Patient Forms” button.

Release of Information Form (Download PDF)

Please click on the button to download our release of information form.

Notice of Privacy Practices (Download PDF)

Your Information. Your Rights. Our Responsibilities. This notice describes how medical information about you may be used and disclosed and how you can get access to this information.

Post Op Prescribing (Download PDF)

Download a copy of policy regarding post op prescribing.

Service and Emotional Support Animals Policy (Download PDF)

Download a copy of our service and emotional support animals policy.