Patient Information

We ask that you arrive at least 15 minutes before your appointment to complete all the necessary paperwork.  For us to best serve your medical needs, you must provide us with as much medical information as possible.

For your convenience, you can download, print and fill out the forms or we can mail the paperwork to you before your appointment to help facilitate this process.

Patient Forms:

Patient Forms for Dr. Jeremias:

Additional Forms:

Self Pay:


Stony Brook Extended Care currently works with over 30 major insurance companies. Our staff is always working on accommodating our patients and their insurance providers. Please call our Centereach office at (631) 542-0550 or our Riverhead office at (631) 740-9181 to find out if your carrier is on our continuously expanding list of providers.

  • Aetna/US Healthcare
  • Aetna International
  • Aetna Meritain Health*
  • Aetna Student Health
  • Aetna Workers' Comp
  • Affinity Health Plan - Medicaid (not Essential)
  • Affinity Medicare Passport Essentials
  • Affinity Medical Passport Essentials NYC
  • Affinity Medicare Ultimate
  • Affinity Medicare Solutions
  • AgeWell NY
  • Alicare Local 277
  • Beech Street
  • CenterLight Healthcare (Comprehensive Care Management)
  • Champ VA
  • Cigna Healthcare (Open Access)
  • Emblem Affinity Medicare Solutions**
  • Emblem Healthcare Partners Essential Plan
  • Empire BC/BS
  • Empire BC/BS Anthem*
  • Empire BC/BS Excellus
  • Empire BC/BS Federal
  • Empire BC/BS Senior Plan (Mediblue)
  • Empire BC/BS Suffolk County
  • Fidelis Medicaid (not Essential)
  • GEHA through Aetna Signature Administrators*
  • GHI Medicare
  • Great West Healthcare (Cigna)
  • Healthfirst (including HNP and SHP) (not Essential)
  • HealthNet Federal Services (Tricare)
  • HealthSmart (WTC Health Program)
  • HIP Medicaid
  • HIP (Healthcare Partners)
  • HIP/Emblem Essential Plan
  • HIP/Emblem Select Care
  • HIP (Vytra VHLI/VHS/VHMS)*
  • HIP VIP Prime
  • HIP VIP Prime Medicare (not Essential)
  • Humana through GHI Network Access
  • Island Group Administrators
  • Magnacare
  • Medicare
  • Medicaid
  • Medi-Share
  • Multiplan/PHCS
  • Oxford Freedom (UHC) (not Metro)
  • Oxford Liberty (UHC) (not Metro)
  • PACE Benefit Plan (CenterLight Healthcare)*
  • Railroad Medicare
  • Senior Home Health*
  • Tricare
  • United Healthcare (UHC)
  • UHC All Savers*
  • UHC Care Improvement*
  • UHC Choice/UHC Choice Plus
  • UHC Community Plan (not Essential)
  • UHC Compass Exchange
  • UHC Compass Rose
  • UHC Definity
  • UHC Family Health Plan**
  • UHC Golden Rule
  • UHC Harvard Pilgrim
  • UHC Health One
  • UHC International
  • UHC Medica Passport
  • UHC Options
  • UHC Optum Veterans Affairs Community Care Program
  • UHC Select Plus*
  • UHC Shared Services (formerly Integrated Services)*
  • UHC Student Services*
  • UMR United Healthcare
  • United/Empire Plan (NYSHIP)
  • US Family Health Plan*
  • Veterans Choice Program*
  • Vytra*
  • Workers' Comp



*Accepted for internal medicine and infectious disease appointments only
**Accepted for obstetrics and gynecology appointments only