Registration forms

For your convenience, our registration forms can be printed prior to your first visit to save you time while in our waiting room. Please be sure to fill out all patient fields and sign where indicated. If you have any questions, please give us a call and a member of our team will be happy to assist. We can be reached by calling (631) 385-8677.

Printable registration forms

Compliance HelpLine

We encourage employees, medical staff, vendors, patients, and business partners to report to Janice Stewart, Compliance Officer at 516.266.5014 or the Compliance HelpLine any actual or suspected violations of the Center’s policies and procedures and/or federal or state law. Calls received by the Compliance HelpLine are most often inquiries but can sometimes be reports of potential misconduct. Our investigatory process includes many methods to determine whether any misconduct occurred. Compliance takes all calls seriously. Inquiries are reviewed by the Compliance Officer and may also be reviewed by other applicable departments.
The Center’s Compliance HelpLine is available 24 hours a day, even days a week. Compliance HelpLine callers may remain anonymous and those who choose to give their name will have their identities protected to the extent allowed by law. The Compliance HelpLine has multi-lingual operators who can take reports from individuals whose first language is not English. The Compliance HelpLine can be reached by calling (800) 894-3226 or by visiting www.Northwell.ethicspoint.com online or by scanning the QR code.