New Patient Appointment Form
Kapoor Cares LLC - To schedule an appointment, please fill out the information below.
Appointment Details
Contact Information
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Date of Birth
Email
example@example.com
How can we help you?
Additional notes:
Please upload a front and back copy of your insurance card. We offer insurance coverage checks as a courtesy, but we cannot guarantee the accuracy of this information. We advise you to verify your in-network status directly with your medical insurance provider. If we find that your insurance is inactive or that our provider is out-of-network, your appointment will still be honored; however, you will need to sign a private pay agreement before the appointment. In the absence of any verified method of payment or reimbursement by in-network insurance, we will have to cancel your appointment. We accept all major insurances, including Medicare, in both New Jersey and New York. While we do not accept Medicaid, we offer sliding scale payment options for those who can provide proof of low-income status.
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