Health and Patient Forms
Providing care regardless of ability to pay.
For your convenience, Harmony Healthcare Long Island has important online patient forms for both existing and new patients available to download. Learn more about these important resources before you request an appointment.
Please download and complete the forms below and bring them with you when you visit Harmony Healthcare Long Island for your first appointment. If you have any questions, please contact us here or call (516) 296-3742.
New Patient Registration Packet
If you are a new Harmony Healthcare Long Island patient, you can download our patient registration form or request it from one of our staff members.
You may complete the new patient form before your appointment to make the registration process easier.
Fill out the patient form completely and bring it with you when you come in for your first appointment. If the form in your language is not available, please contact us.
Patient General Consent Form
Eligibility Determination for Sliding Fee Discounts
Sliding Fee Scale
Privacy Notice of Privacy Practice Consent Form
Patient Rights and Responsibilities
As a Harmony Healthcare Long Island patient, you have certain rights that provide you with basic protections when you are under our care.
The New York State Department of Health requires all health care facilities to inform those seeking health services about their rights and responsibilities. It is part of your registration as a patient and a key part of your health care plan.
Patient Bill of Rights for Adults
Patient Bill of Rights for Parents
You can also learn more about your rights and responsibilities at any of our conveniently located Harmony Healthcare Long Island locations. If the form in your language is not available, please contact us.
NuHealth Privacy Notice
We are committed to maintaining the privacy of your protected health information.
Harmony Healthcare Long Island policies comply with the Federal HIPAA (Health Insurance Portability & Accountability Act) regulations.
Read this privacy notice that describes how your medical information may be used and disclosed and how you can access this vital information.