Emblem, HIP, GHI ( Prism )

**These specific forms are required for authorization by these health plans.**

 Please fill out and print the following forms:

Back Index(Only necessary to fill out if the condition is related to your back)

Neck Index (Only necessary to fill out if the condition is related to your neck)

Patient History Form

Chiropractic Healthcare of St. James

Address

338 Lake Ave,
St. James, NY 11780

Phone

(631) 584-8100

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Please do not submit any Protected Health Information (PHI).

Location

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Chiropractic Healthcare of St. James

Address

338 Lake Ave
St. James, NY 11780

Contact Information (631) 584-8100

(631) 584-9436

[email protected]

Office Hours

Monday  

9:00 am - 1:00 pm

4:00 pm - 8:00 pm

Tuesday  

3:00 pm - 7:00 pm

Wednesday  

9:00 am - 1:00 pm

4:00 pm - 8:00 pm

Thursday  

Closed

Friday  

9:00 am - 1:00 pm

4:00 pm - 8:00 pm

Saturday  

8:30 am - 12:00 pm

Sunday  

Closed

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