Health and Longevity | New Patient Forms
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Download New Patient Forms

Please take the time to carefully complete each form. Many tests you will have at your first visit are based on the evaluation of the health history questionnaire.

Please Note: It is important that we receive all forms prior to your appointment.

Click the link below to begin downloading the forms.

*A ZIP file is a collection of files that have been compressed (reduced) in size, and then bundled together into one single file. To unzip (uncompress and unpack) the internal files, you need to use a program such as WinRAR.

How Do I Submit the Forms?

  1. Bring the physical forms with you the day of your first visit.
  2. or Send them to: The Salerno Center 12 East 52nd St. 4th Fl., New York, NY 10022.
  3. Fax them to: 212.582.1727 (Please put “Attn: New Patient Coordinator” on your fax cover sheet.)

What Do I Need to Bring to My First Visit?

  • It is imperative that you send, or bring with you, any lab work you’ve completed within 6 weeks of your appointment or Dr. Salerno will have to repeat the tests.
  • Also, send or bring written reports of the most recent tests (X-rays, EKG…) that you have had within a year prior to your appointment to aide in your health evaluation.
The Salerno Center for Complementary Medicine
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