Registration Form

Open the new patient registration form as a fillable PDF, complete it digitally or print it, and choose the submission method that works best for you.

Step 1

Open the Fillable PDF

Use the form online, save a copy for yourself, or print it before your visit if that is easier for you.

Open Registration Form Download PDF

If your browser supports it, you can fill in the PDF directly. You can also print it and complete it by hand.

Need this form in an accessible format or need help completing it? Please contact the office or review the nondiscrimination and language assistance notice. Accessibility notice (PDF)

Step 2

Choose How to Submit

You may use whichever method is most convenient for you before your first visit.

Bring it to the office

You may submit the completed form in person at the front desk when you arrive.

Fax it to the clinic

Fax completed forms to 516-706-3880.

Email it

You may email the completed form to the clinic if that is easier for you. contact@drouyangcare.com

Complete it at the front desk

If you prefer, you can also complete the registration form in person at the front desk before the visit begins.

Questions Before Your First Visit?

If you are unsure which submission method to use, or want to double-check office details before arriving, the Contact page has the clinic address, phone, fax, email, and office hours in one place.

Go to Contact