Print and then fill out your form:
Along with your completed form, please remember to bring your photo ID, your insurance card and a method of payment.
PDFs require Adobe Reader to view and print, which can be downloaded here.
Patient: Connecticut
We are proudly associated with Yale New Haven Health in Connecticut and New York. We, also, work collaboratively with local providers, including your primary care or specialty doctor, across Connecticut and New York.
Our experienced providers are trained in emergency, family, and internal medicine. In fact, you’ll find many are the same experts who have treated patients in local area hospitals.
For information on the estimated cost of a self-pay visit, please visit our Price Transparency page.
If you have a question regarding billing, please visit our Billing and Insurance page to learn more.
To pay your bill online visit our Billing and Insurance page.
Yes, we accept most major insurances. Your co-pay is collected and required at the time of service. Please visit our Accepted Insurance page for more information.