Patient Information

Thank you for choosing Stony Brook Pediatrics of Sayville.

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

For your convenience, you can complete your paperwork prior to your appointment.

Your options are:

  • Print and complete the forms listed below
  • Using Adobe Acrobat Reader, download, fill-in and print the forms below
  • Request the forms to be mailed to your home

Once completed, remember to bring your forms with you to your appointment.

 

Patient Forms:

Additional Forms:

Self Pay:


Referrals

As part of Stony Brook Children's, we can now offer a wide array of leading-edge clinical programs, support groups, and prevention and education services—many of which are not available elsewhere in the community. With physicians available in 30 pediatric specialties, Stony Brook Children’s has the capabilities and expertise to treat almost all childhood conditions — from routine assessments to complex medical interventions. 


Insurance

Stony Brook Pediatrics of Sayville currently works with over 30 major insurance companies. Our staff is always working on accommodating our patients and their insurance providers. Please call our office at (631) 563-8190 to find out if your carrier is on our continuously expanding list of providers.

 

  • Aetna/US Healthcare (not Flexible Five or Upfront Advantage)
  • Aetna International
  • Aetna Meritain Health
  • Aetna Signature Administrators
  • Aetna Student Health
  • Affinity Medicaid (not Essential)
  • Alicare Local 277
  • Beech Street
  • CenterLight Healthcare (Comprehensive Care Management)
  • Champ VA
  • Cigna Healthcare (Open Access)
  • Emblem Healthcare Partners Essential Plan
  • Empire BC/BS
  • Empire BC/BS Excellus
  • Empire BC/BS Federal
  • Empire BC/BS Senior Plan (Mediblue)
  • Empire BC/BS Suffolk County
  • Empire Blue Access (non-local plans)

 

  • Empire Blue Healthplus (formerly Healthplus Amerigroup)
  • Fidelis Medicaid (not Essential)
  • GHI CBP
  • GHI HMO
  • GHI Medicare
  • Great West Healthcare (Cigna)
  • Healthfirst (including HNP and SHP) (not Essential)
  • HealthNet Federal Services (Tricare)
  • HIP Medicaid
  • HIP (Healthcare Partners)
  • HIP/Emblem Essential Plan
  • HIP/Emblem Select Care
  • HIP VIP Prime
  • HIP VIP Prime Medicare (not Essential)
  • Humana through GHI Network Access
  • Island Group Administrators
  • Magnacare
  • Medicare
  • Medicaid
  • Multiplan/PHCS
  • Oxford Freedom (UHC) (not Metro)
  • Oxford Liberty (UHC) (not Metro)
  • Railroad Medicare
  • Tricare
  • United Behavioral Health (Optum Health)
  • United Healthcare (UHC)
  • UHC Choice/UHC Choice Plus
  • UHC Community Plan (not Essential)
  • UHC Compass Exchange
  • UHC Compass Rose
  • UHC Options
  • UMR United Healthcare
  • United/Empire Plan (NYSHIP)
  • US Family Health Plan
  • Workers' Comp

 

 

**Disclaimer**

Insurance plan participation may change over time. While every effort is made to ensure the accuracy of this information, we recommend that you confirm participation status with your insurance carrier or practice. Please note that insurance plan participation requirements may be waived when a patient receives medical treatment in an emergency.