What to Bring to Your Appointment

• Your insurance card
• Physician referral forms if required by insurance
• A list of current prescriptions and/or over-the-counter medications you are taking, including dose and frequency
• Pertinent information about your medical and surgical history
• Any recent x-rays or appropriate records you may have

Patient Forms

You can view and/or print the necessary patient forms for your appointment by clicking on the links below.

Patient Registration Form (PDF)
Patient History Form (PDF)
[PDF Help]

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Insurance and Payment Information

We accept many forms of insurance and our office staff can help you file claims or answer questions. Bring your insurance information to your office visit and be sure to notify us if there is any change in your coverage. Please remember that it is your responsibility to pay any deductibles, co-payments, or non-covered services at the time of your visit. If you have any questions regarding which insurance plans we accept or any patient billing concerns, please call us at the phone number below. Questions regarding your coverage and benefits should be directed to your employer or insurance company. We accept cash, checks, MasterCard and Visa for your convenience. Payment plans are available if necessary, but should be discussed with the office manager.

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Prescriptions & Refills

Please check your medications before coming to the office so that we may arrange for a refill at the time of your visit. In the event that you need a prescription refill outside an office visit, please call the pharmacy where the prescription was originally filled, and have them call our office with the appropriate information.

Records Release & Test Results

We regard your medical records as confidential. Your records will only be released to the appropriate physician or facility with your written authorization. Your physician is the only one who can release test results. At his discretion he may have the staff contact you regarding your results.

Notice of Privacy Practices

Jacob Zamstein, MD, LLC, wishes to present our

Notice of Privacy Practices (PDF).  [PDF Help]

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