Patient Forms
Please take a minute to review our Patient Forms and Insurance sections below, and give us a call when you are ready to schedule an appointment.
If you are a new patient or haven't been seen within this past year, or if you have a new injury, you will need to bring both the patient information form and the registration form to your first appointment.
When arriving for your appointment, please be sure you bring:
- Photo ID (i.e. driver’s license)
- Your current insurance card(s)
- Your co-pay as indicated in your insurance contract
- Referral from your Primary Care Physician, if applicable
- Appropriate form of payment for those patients with no insurance
Please print, complete, and bring with you each of the forms listed below:
When making your appointment, please let us know if this is either a work related issue or an injury resulting from an automobile accident. Additional authorization, documentation or paperwork may apply. If you have any questions, please call: (203) 433-0906
What Insurances Do We Accept?
We accept all insurances and participate with the majority of major health care plans. Below is a list of the most common health care programs in which Dr. Lieponis participates.
If you do not see your health plan listed below, please call our office at (203) 433-0906 to confirm that your plan is accepted.
Please note that the list of participating insurance providers is subject to change. please call our office or use the above links to connect to the insurance company directly.