Before your appointment with, quickly and conveniently access patient forms below. Please bring your completed forms with you to our office at the time of your visit.
Note: To view the forms listed below, you will need Adobe Reader. You may download Adobe Reader for free at www.adobe.com.
Health related forms such as consent, patient representation, and more.
Cornerstone Family Healthcare welcomes all people in need of medical care, regardless of their insurance status or ability to pay. A Sliding Fee Scale Discount Program is offered to all eligible patients. If you and your family do not have health insurance, Cornerstone’s Patient Services team can review your options and help you choose a plan that is right for you.
Cornerstone Family Healthcare accepts most major health insurance plans. Before selecting a Cornerstone provider, please check with your insurance company to verify your eligibility and coverage to ensure the provider participates in your plan. For a list of insurance plans Cornerstone Family Healthcare accepts, please click here:
Cornerstone Family Healthcare provides essential medical services regardless of a patient’s ability to pay. If you are uninsured or have a high-insurance deductible, the Sliding Fee Discount Program assures that all patients (with and without health insurance coverage) have access to medical care services. Eligibility for the Sliding Fee Discount Program is based upon poverty guidelines established by the Federal Government and are determined by family size and income.
To apply for sliding fee services and alternate payment arrangements you will need to provide proof of income for yourself and any individual in your household. We will require any one of the following items:
Insured patients with income at or below 200% of the FPL are eligible for the Sliding Fee Scale discount. Eligibility is based on income and family size in accordance with the most recent Federal Poverty Guidelines. If eligible, Cornerstone will bill the insurance first, then apply the sliding fee discount by charging a fee no greater than what would be charged to a patient who has no public or private insurance in a defined income category.
Patients interested in the Sliding Fee Scale Program should contact 845-563-8000 for more information.
Please allow at least one hour prior to your medical appointment to apply for the Sliding Fee Scale Program.
147 Lake Street
Monday – Thursday: 9 AM – 7 PM
Friday: 9 AM – 5 PM
Saturday: 9 AM – 1 PM
10 Benton Avenue
Monday – Friday: 9 AM – 5 PM
140 Hammond Street
Monday – Wednesday: 9 AM – 5 PM
<span data-metadata="">View and download forms
View and download forms
View and download forms
View and download forms
View and download forms
<span data-metadata="">View and download forms
Cornerstone Family Healthcare accepts the following insurance plans:
