Please note that you will receive a text and email three days prior to your appointment from Phreesia, prompting you to complete your new patient registration packet. If for any reason you can't complete forms electronically, please complete and print the forms provided below to bring to your appointment. 

If you cannot do either, please arrive 15 minutes prior to your appointment to complete the paperwork.

Your options are:

• Complete new patient registration forms via Phreesia
• 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

Patient Forms:

• Patient Registration Packet (English)
• Patient Registration Packet (Spanish)

Additional Forms:

• Patient History Form (English)
• Patient History Form (Spanish)
• Medical Record Release Form (English)
• Medical Record Release Form (Spanish)

Self Pay:

• Financial Agreement (English)
• Financial Agreement (Spanish)

Once completed, remember to bring your forms with you to your appointment. To better serve your medical needs, we ask that you provide us with as much medical information as possible.

Helpful Links

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

• American College of Obstetricians and Gynecologist 
• La Leche League: A non-profit organization that provides mother to mother support and helps women who want to breastfeed their children
• National Osteoporosis Foundation
• Southampton Hospital: Our community hospital with maternity services

Business Office and 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.

Good Faith Estimate

If you are uninsured, you have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost.

Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.

• You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
• Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
• If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
• Make sure to save a copy or picture of your Good Faith Estimate.

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call our office.

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.
 

**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.