Documents & Forms
For your added convenience, you can print out your new patient forms at home and bring them into the office for your first appointment. Please click the boxes below to download the appropriate form.
All new patients of Dr. Robert Zingale must complete the “New Patient Registration Form”. Please open the form, complete it, and print it. Be sure to bring the form with you to your initial appointment with Dr. Zingale.
No-Fault & Workers’ Compensation Information Form
You may be asked to fill out the “No-Fault & Workers’ Compensation Information form”. Please click the button below to open the form in PDF format and print it out. Be sure to bring the completed form with you during your scheduled appointment.
Medication, allergy, hospitalization & Surgery Questionnaire
To ensure that our patient records are up-to-date, we require that all patients who have not seen Dr. Zingale in over 6 months to complete the following Medication, Allergy, Hospitalization & Surgery Questionnaire. Once completed, please save the form and print it out. Be sure to bring the completed form with you during your scheduled appointment.
The definition of “protected health information” means any written or oral information about you, including demographic data that can be used to identify you, created or received by your healthcare provider, which relates to your past, present, or future physical or mental health or condition.
Click the link to download our Privacy Notice Document (HIPAA) form.