Patient Information

Patient InformationIf the patient is taking medication for another condition or has specific allergies, we need to know before beginning treatment. We can accommodate the patient’s needs and help ensure their treatment is effective. We can also make changes to the treatment when necessary. With this information, we can also keep the information in our records for reference during future appointments.
Patient Portal
Patient Forms
To fill out the Telemedicine Consent form, click the button below.  Once completed, email the form to [email protected]
Telemedicine Consent Form
Request An Appointment

First & Last Name (Required)

Email (Required)

Phone Number (Required)

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New Clients

By gathering information on the patient’s current condition and medical history, we can customize the treatment to their needs.

New Clients

Payment Methods – Cash or Credit Accepted

Payment Methods – Cash or Credit Accepted

Your Passaic Primary Physician

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