STEP 1 – Complete all enrollment forms and membership agreement.
Please download the enrollment packet and complete the following enrollment forms:
- Screening Questionnaire
- Risk Review & Physical Approval From (for your physician to complete)
Your doctor’s office can FAX your physician approval form to (914) 597-2796.
- Health Review Form
- Liability Waiver
- Membership Agreement
STEP 2 – Return all forms to the Restorative Neurology Clinic by one of three options:
- Email: firstname.lastname@example.org
- Fax: (914) 597-2796
- Mail to:
Burke Restorative Neurology Clinic – Robotics
785 Mamaroneck Avenue, The Burke House
White Plains, New York 10605
We will call to schedule an appointment only when all forms have been received.