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 complete your paperwork in advance of your appointment. Your options are:

  • Print and complete the forms listed beow
  • 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:


Helpful Links

For more information about breastfeeding or testing, use these links to begin your health research.


Business Office & Insurance Information

Hamptons Gynecology and Obstetrics has a business office staffed with professional, courteous and highly experienced individuals who are knowledgeable about insurance issues and procedures.

They personally counsel each patient who requires extended care. For surgery patients and maternity patients, they obtain the necessary authorizations.

We participate with all the major insurance carriers and are available to assist and answer billing or insurance questions during business hours Monday through Friday from 8:00am - 4:30pm. Call (631) 444-4800 for more information.


Insurance

Hamptons Gynecology and Obstetrics currently works with over 30 major insurance companies. Our staff is always working on accommodating our patients and their insurance providers. Please call our Southampton office at (631) 283-0918 to find out if your carrier is on our continuously expanding list of providers.
 

  • Aetna/U.S. Healthcare
  • Aetna International
  • Aetna Meritain Health
  • Aetna Signature Administrators
  • Aetna Student Health
  • Aetna Workers' Comp
  • Affinity Medicaid (not Essential)
  • Affinity Medicare Passport Essentials
  • Affinity Medicare 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 Excellus
  • Empire BC/BS Federal
  • Empire BC/BS Senior Plan (Mediblue) (not Select)
  • Empire BC/BS Suffolk County
  • Fidelis Medicaid (not Essential)
  • GHI CBP
  • GHI HMO
  • GHI Medicare
  • Great West Healthcare (Cigna)
  • Healthfirst (including HNP & SHP) (not Essential) (not MCR)
  • HealthNet Federal Services (Tricare)
  • HealthSmart (WTC Health Program)
  • HIP Medicaid
  • HIP (Healthcare Partners)
  • HIP/Emblem Essential Plan
  • HIP/Emblem Select Care
  • HIP VIP Prime
  • HIP VIP Prime Medicare
  • 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)
  • Railroad Medicare
  • Tricare
  • United Healthcare (UHC)
  • UHC Choice/UHC Choice Plus
  • UHC Community Plan (not Essential)
  • UHC Compass Exchange
  • UHC Compass Rose
  • UHC Options
  • UHC Optum Veterans Affairs Community Care Program
  • UMR United Healthcare
  • United/Empire Plan (NYSHIP)
  • US Family Health Plan
  • Workers' Comp